The process of symptom appraisal: cognitive and emotional responses to detecting potentially malignant oral symptoms

Following the self-discovery of symptoms of oral cancer, approximately 30% of patients wait for more than 3 months before seeking attention from a health care professional. Although symptom appraisal is known to be an important stage in the decision to seek help, little is known about the process of symptom appraisal. The aims of the current study were to produce a theory-guided investigation of the specific cognitive interpretations and emotional reactions to the self-discovery of potentially malignant oral symptoms and to gain understanding as to why these may change prior to help seeking.

In-depth semi-structured interviews were conducted with 57 consecutive patients who had been referred with potentially malignant oral symptoms. Participants were asked about symptom detection, initial and subsequent beliefs about symptoms, and emotional responses prior to their first visit to a health care professional. The tape-recorded interviews were transcribed verbatim and analyzed using "framework analysis."

Patients often attributed the symptoms to transient, minor conditions such as mouth ulcers, physical trauma, or dental problems and, in turn were unconcerned about their presence. Patients infrequently attributed their symptoms to cancer. Origins of specific interpretations included previous experiences, specific symptomatology, logical associations with the perceived cause, and information from medical literature. Stimuli for reinterpretation included receipt of new information, symptom development, and persistence of symptoms.

This study has documented the process of symptom appraisal and indicates that an individual's interpretation of potentially malignant oral symptoms is often misguided.