Discussion Our findings highlight that the presence of fatalistic attitudes which may be associated with longer time to presentation5,6. Evidence suggests that it is possible to change

fatalistic attitudes depending on the context7,8. Lived experiences, particularly bad ones, may influence an individual to having fatalistic attitudes and fears about cancer9, and in

turn their help-seeking behaviour5,6. Our findings also revealed that symptoms that interfered with the interviewees’ daily living superseded their fatalistic attitudes and

promoted earlier consulting than normal, as confirmed by previous research10. Improving the cancer public image was mooted by previous research which revealed that

people seemed to be in ‘two minds’ about cancer11. Strategies, like ‘seeking support from other cancer survivors’9(p633) were recommended in order to overcome fears and

fatalistic attitudes in cancer survivors and their communities.

Background Beliefs and attitudes may influence time to help-seeking for potential cancer symptoms1,2 among older people. We sought to explore the influence of

fatalistic attitudes towards ill-health and dying on help-seeking behaviour among older people.

Methods We purposively sampled people over 60 years from a large general practice-based questionnaire study of smokers and non-smokers who had agreed to be

interviewed (n=241). We explored issues around fatalism using the Powe Fatalism Inventory3 and how the expression of fatalistic beliefs (or absence of them) may connect

with help-seeking behaviour and responses to awareness-raising initiatives. Data were analysed using framework analysis4 and NVivo. Regular discussions were held by the

research team.

Findings We interviewed 17 smokers, 16 ex-smokers and 9 never-smokers (42 interviews). There was no obvious association between smoking status and fatalism score

obtained from the Powe Fatalism Inventory (p=0.396). Our interview findings suggested that an individual’s ‘lived experiences’ influenced one’s fatalistic attitude which in turn

influenced their help-seeking behaviour (see illustration below). Lived experiences’ included having: symptoms that interfered with daily living, previous experience with

potentially serious symptoms and cancer experience. Fatalistic attitudes were: The belief that ‘cancer is a death sentence’; ‘The inevitability of death’ and ‘Viewing the

possibility of cancer as fate’. These beliefs acted as a barrier to help-seeking in older people. The attitudes were however superseded by ‘symptoms that interfered with

one’s daily living’ whereby the interviewee was forced to consult earlier than normal.

Conclusion

To overcome the fatalistic attitudes and improve help-seeking for cancer symptoms in older people, particularly in individuals who have experienced ‘bad’ lived experiences, in-

novative interventions addressing fatalistic beliefs, for example, sharing positive personal narratives about early diagnosis and cancer, may be required.

Fatalistic attitudes:

The belief that ‘cancer is a death sentence’

‘Soon as they tell you they’re gonna check you for cancer you think,

the end is nigh!’ (R1, male, 60-69 age group, current smoker, fatalism score=15/15; has asbestosis-

related disease and diabetic; cancer experience-no cancer survivors; had poor quality

of life during treatment)

‘The inevitability of death’

‘...it doesn't matter what your lifestyle is, you're going to die anyway,

we're all going to die sometime aren't we?...Just a matter of what

with and how long…’ (R2, male, 70+ age group, never-smoker, fatalism score=8/15; emphysema; has cancer experi-

ence, father died after a heart attack, has a pace maker)

‘Viewing the possibility of cancer as fate’

‘...no matter what you're doing in your life, eating, exercising, healthy and all

that, it will, if it's going to be there it's going to happen…’ (R3, female, 60-69, ex-smoker, fatalism score=6/15, recovering from pneumonia, survived

breast cancer twice and partner had bowel cancer)

Lived experiences

Cancer experience

Previous experience of potentially

serious symptoms

Symptoms that interfere with daily life

Cross-sectional quotes:

‘...died’; ‘ asbestos-related disease’, ‘diabetes’,

‘strokes’, ‘hypertension’, ‘suffering pain on

the...pipe that goes down into your stomach’,

‘prostate cancer’, ‘two marks on my

face….biopsies taken yesterday’, ‘still coughing

now… a heart attack….suffering with arthritis’,

‘cholesterol tablets’, ‘underactive thyroid…’

Reasons to consult doctor

‘If I saw blood in my, err, stools, yeah I’d go to the doctor’s...’ (R1, male, 60-69 age group, current smoker, fatalism score=15/15; has asbestosis-related disease and diabetic; cancer

experience-no cancer survivors; had poor quality of life during treatment)

So I would go to the doctor's if there's a problem that I can't cure myself (R4, male, 60-69 age group, current smoker, fatalism score=4/15, has cancer experience-no survivors)

Fatalistic attitudes, ‘lived experiences’ and help-seeking behaviour

for potential cancer symptoms in older people:

A qualitative interview study

Julie Walabyeki1 Julie Seymour1, Helena Sinclair1, Katriina Whitaker2, Joy Adamson3 Karl Atkin4, Una Macleod1

1: Hull York Medical School, University of Hull, Cottingham Road, Hull HU6 7DZ; 2: School of Health Sciences, University of Surrey, Surrey; 3: Institute of Health & Society, Newcastle University, Newcastle Upon Tyne; 4: Department of Health

Sciences, University of York, York. Contact for further information: Julie.Walabyeki@hyms.ac.uk

Acknowledgements Julie Walabyeki is funded by the Early Diagnosis and Advisory Group, Cancer Research UK. The research team acknowledges the support of the National Institute for Health Research Clinical Re-

search Network. We are grateful to all the Yorkshire study participants. We thank Thomas Hammond, Hull York Medical School, for his exemplary administrative assistance and transcription skills; and

Dr Judith Dyson, for her contribution and support.

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