Journal scan

Why do patients delay reporting neutropenic sepsis?

Delays in the treatment of chemotherapy-associated neutropenic sepsis (NS) are associated with significant morbidity and mortality approximately 700 people die each year in the UK due to such sepsis. But what are the factors that contribute to patients delaying reporting of their NS symptoms?

A doctoral researcher from London investigated the rationale for the deferment and delay in reporting symptoms associated with this experience. Enhanced communication between professional staff and patients, and their carers could, the author suggests, lead to improved outcomes.

Using a constructivist grounded theory method, this longitudinal qualitative study incorporated 31 interviews with women with breast cancer, their carers and clinicians, and 13 hours of observations of clinical consultations, from a UK cancer centre over the period November 2011 and February 2013.

All of the patients

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Delays in the treatment of chemotherapy-associated neutropenic sepsis (NS) are associated with significant morbidity and mortality – approximately 700 people die each year in the UK due to such sepsis. But what are the factors that contribute to patients delaying reporting of their NS symptoms?


Chemotherapy-associated neutropenic sepsis kills around 700 people in the UK each year. Photo: SPL

A doctoral researcher from London investigated the rationale for the deferment and delay in reporting symptoms associated with this experience. Enhanced communication between professional staff and patients, and their carers could, the author suggests, lead to improved outcomes.

Using a constructivist grounded theory method, this longitudinal qualitative study incorporated 31 interviews with women with breast cancer, their carers and clinicians, and 13 hours of observations of clinical consultations, from a UK cancer centre over the period November 2011 and February 2013.

All of the patients in this sample described delays or postponing reports of their symptoms suggestive of sepsis, often repeatedly; three women never informed their clinical team of their experience.

Such delays were disconcerting for the doctors but, in some instances, the conceptual fear of chemotherapy or its consequences often meant clinicians softened the discussions on the seriousness of sepsis, or otherwise moderated the explanation. The use of ‘scare tactics’ and emphasis on the risks was, however, recognised as another strategy to compel compliance with neutropenic sepsis management strategies.

The establishment and use of affinities that facilitate assistance were found to be key factors: the perceived lack of a relationship with practitioners, such as those who seemed rushed when manning designated helplines, and the exclusion of male carers, who were often, therefore, ignorant of the implications of sepsis, were noted.

Oakley C, Taylor C, Ream E et al (2016) Avoidant conversations about death by clinicians cause delays in reporting of neutropenic sepsis: grounded theory study. Psycho-oncology. doi: 10.1002/pon.4320

Journal scan is ​compiled by Dion Smyth, lecturer-practitioner in cancer and palliative care, Birmingham City University

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