Dealing with symptoms in the general population: lessons learned from the Danish Symptom Cohort

[摘要] Every day many people experience symptoms ranging from barely noticeable sensations to disturbing discomforts. The causes vary from normal physiological processes and self-limiting benign conditions to life-threatening diseases. Symptom experiences do not occur as stand-alone events but are influenced by an interchange of biological, psychological, and cultural factors, leading to various ways of interpreting and managing symptoms.1 Consequently, many symptoms are managed privately without consulting the healthcare system;2 however, some symptoms should lead to further investigation as they are alarming from a healthcare perspective and timely investigation is warranted.3,4 GPs play an important role in helping patients interpret symptoms;5 however, the healthcare-seeking process is not simple, and numerous factors, including previous experiences, social relations, and support, may contribute in deciding whether or not to seek health care.620 years to complete a questionnaire covering 44 predefined symptoms comprising both cancer symptoms as well as common symptoms, for example, back pain, urinary incontinence, and tiredness. If responders confirmed a symptom experience, follow-up questions were asked concerning onset, influence on daily activities, concerns about the symptom, whether the responder had consulted the GP regarding the symptom, and considerations about contacting the GP with the symptom in question. Responders were also asked about smoking status, alcohol intake, and physical activity. For the invitees, socioeconomic status (education, income, cohabitation status, ethnicity, and labour market affiliation) were then collected from national registers7–11 and linked to survey data.In this editorial we summarise the findings from the DaSC studies, highlighting the lessons learned but also pointing to what needs to be further explored in the 10-year follow-up questionnaire, DaSC II, which was distributed in May 2022.The 34 current publications deriving from the DaSC are available online,12 with details of the results and contextualisation of findings within the existing literature.FREQUENCY OF SYMPTOMS AND GP CONTACT The survey response rate was 52.2%. The median age was 51 years (interquartile range 38–65 years), and responders were fairly representative of the study sample.About 9 out of 10 individuals reported at least one of the 44 predefined symptoms within the preceding 4 weeks. Prevalence estimates varied from 49.4% ( n = 24 537) reporting tiredness to 0.1% ( n = 54) reporting blood in vomit. The mean number of reported symptoms was 5.4 (males 4.8; females 6.0) and 37% contacted their GP about at least one symptom.The symptoms leading to the highest proportion of GP contacts were relatively infrequently reported symptoms with visible signs, such as blood in the urine, blood in semen, and coughing up blood. For potentially more serious symptoms such as unintentional weight loss, rectal bleeding, or post-menopausal bleeding, no more than one-third reported having contacted their GP.The DaSC study results increase understanding of the complexity of symptom experiences and healthcare-seeking behaviour in the general Danish population, which in many ways is comparable to the UK and other western European populations. As would be expected, most symptoms are not presented to the GP. Many bodily sensations such as tiredness are common and seldomly on their own a sign of disease. Thus, it seems appropriate that the public does not present as patients with such a symptom. However, it is disturbing that some symptoms indicative of potentially serious diseases, such as rectal bleeding, only infrequently lead to GP contact, and that to some extent such symptoms are perceived as too embarrassing to discuss with the GP. Likewise, it is thought-provoking that benign symptoms, such as urinary incontinence and erectile dysfunction, rarely lead to GP contact even though the symptoms are reported as bothersome. These symptoms are common and often treatable. Both GPs and patient organisations could be important facilitators in disseminating knowledge about symptoms and treatment options to the general population, thereby decreasing feelings of taboo and shame, and improving quality of life for many people.

[学科分类] 卫生学