{
  "abstract": "Background Rural cancer inequalities are well-established, but their causes have yet to be determined. While late diagnosis is thought to contribute, potentially due to distance to healthcare services, evidence to support this is inconclusive. Barriers rural residents face in relation to help-seeking, and how barriers vary within and across rural communities, are not understood.We aimed to identify and examine variations in barriers to help-seeking for symptoms of possible colorectal cancer, among people residing in rural areas.Methods 3,400 eligible patients from four primary care practices in rural Yorkshire were invited to participate in the study. Consenting participants completed a survey about recent symptomatic experience, and beliefs about accessing healthcare.Barriers to accessing primary care were grouped into three domains and scored: individual level, primary care, contextual/systemic. ANOVAs (Analysis of Variance) were used to investigate variations in mean domain score across fixed characteristics (sex, Index of Multiple Deprivation (IMD), age, rural category, employment, education, practice size, distance and travel time to primary care).Results 722 surveys were returned (response rate = 21%). Consultation for symptoms was significantly associated with deprivation and age. Those living in the least rural areas, and those registered at larger practices, had significantly higher mean barrier scores across all domains. Those living in the least deprived areas had the highest means across all three domains. Women, younger participants and those who were working had significantly higher mean contextual barrier scores. Work commitments, appointment availability, doctor/patient relationship and road infrastructure were the most reported barriers to help-seeking.Conclusion This is one of the first studies to undertake a granular examination of help-seeking behaviours and barriers for people residing in diverse rural areas. We found no association between degree of rurality and likelihood of consultation. Surprisingly, individuals in less remote areas and those registered at larger practices reported more barriers to help-seeking, challenging the assumption that the most remote patients face the greatest obstacles to consultation. Further work is required to understand how degree of rurality, and patients’ relationships with primary care affect cancer pathways, and what can be done to support early diagnosis amongst rural cancer patients.",
  "authors": [
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK"
      ],
      "name": "Emily Haworth"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK"
      ],
      "name": "Linda Sharp"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK"
      ],
      "name": "Jennifer Deane"
    },
    {
      "affiliations": [
        "JJR MacLeod Centre for Diabetes, Endocrinology and Metabolism, Aberdeen Royal Infirmary, Aberdeen, UK"
      ],
      "name": "Christina Ellwood"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK"
      ],
      "name": "Greg Rubin"
    },
    {
      "affiliations": [
        "Division of Applied Health Sciences, Section of Academic Primary Care, University of Aberdeen, Aberdeen, UK"
      ],
      "name": "Peter Murhcie"
    },
    {
      "affiliations": [
        "School of Health and Wellbeing, University of Glasgow, Glasgow, UK"
      ],
      "name": "Sara MacDonald"
    },
    {
      "affiliations": [
        "Independent Researcher, N/A, Newcastle Upone Tyne, UK"
      ],
      "name": "Lorraine Angell"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK"
      ],
      "name": "Christina Dobson"
    }
  ],
  "title": "P24 Barriers to consulting for symptoms of possible colorectal cancer in rural populations: a questionnaire survey",
  "uid": "93932861-7fbe-5f76-b9d1-5b2670b6962d"
}