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Zucchelli MM, Gambetti E, Giusberti F, Nori R. Use of default option nudge and individual differences in everyday life decisions. Cogn Process 2024; 25:75-88. [PMID: 37740853 DOI: 10.1007/s10339-023-01161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Abstract
People often make inefficient decisions for themselves and the community (e.g. they underuse medical screenings or vaccines and they do not vote) also because of their individual characteristics, such as their level of avoidance or anxiety. In recent years, governments have successfully applied strategies, called "nudges", to help people maximizing their decisions in several fields; however, the role of individual characteristics has been poorly explored. The present study investigated whether one kind of nudge, the default option (automatic enrolment in a specific plan), can modulate the influence of such individual differences, promoting favourable decisions in different field, such as the medical and civic ones. One hundred and eighty-three participants completed the Trait Anxiety Inventory, the General Decision-Making Styles Inventory and scenarios about health and civic decisions. Participants have hypothetically been enrolled by default or not enrolled in specific plans and had to decide whether adhere or not to the plan proposed. Result showed that the default option drives anxious and avoidant individuals, who usually refuse to make a choice due to their overestimation of negative events' occurrence, to undergo medical screenings and vaccine and to vote more. Nudge confirmed its effectiveness in favouring better decisions among people according to their individual differences.
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Affiliation(s)
- Micaela Maria Zucchelli
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| | - Elisa Gambetti
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Fiorella Giusberti
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Raffaella Nori
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
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Beach WA, Canary HE, Chen YW, Daly BM, Gammon A, Savage MW, Madlensky L, Kaphingst KA. Communication About Negative and Uncertain Results: Interactional Dilemmas During a Genetic Telehealth Consult. HEALTH COMMUNICATION 2023; 38:3252-3263. [PMID: 36415031 PMCID: PMC10200822 DOI: 10.1080/10410236.2022.2145770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This case study focuses on a video telehealth consult to discuss genetic testing results. Participants include a Genetic Counselor (GC) and a Patient (P) previously diagnosed with ovarian cancer who is currently undergoing chemotherapy treatments. Utilizing conversation analysis (CA), attention is first given to a series of interactional dilemmas as GC delivers and P responds to negative, uncertain, and complex test results. Specific findings address practices employed by GC to structure the encounter and establish authority, impacts on P's participation and understandings, recurring and at times problematic orientations to "negative" findings, and inherent ambiguities faced by GC and P when attempting to discern good and bad news. Close examination of these moments provides a unique opportunity to identify, describe, and explain genetic counseling as a co-produced, interactional achievement. These findings are then integrated with patient's post-counseling survey (susceptibility, anxiety, uncertainty, fear, and hope), including reported experiences which broaden understandings of the interactional environment. Specific recommendations are raised for improving counseling skills, enhancing patients' understandings, and building therapeutic alliances addressing both patients' emotional circumstances and the complexities of genetic test results.
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Affiliation(s)
| | | | - Yea-Wen Chen
- School of Communication, San Diego State University
| | | | | | | | - Lisa Madlensky
- Department of Medicine and Moores Cancer Center; University of California San Diego
| | - Kimberly A. Kaphingst
- Huntsman Cancer Institute, University of Utah
- Department of Communication, University of Utah
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González-Ruiz I, Ramos-García P, Ruiz-Ávila I, González-Moles MÁ. Early Diagnosis of Oral Cancer: A Complex Polyhedral Problem with a Difficult Solution. Cancers (Basel) 2023; 15:3270. [PMID: 37444379 DOI: 10.3390/cancers15133270] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Oral and oropharyngeal cancers are a growing problem, accounting for 377,713 and 98,412 new cases per year all over the world and 177,757 and 48,143 deaths annually, respectively. Despite the substantial improvement in diagnostic procedures and treatment techniques in recent years, the mortality rate has not decreased substantially in the last 40 years, which is still close to 50% of cases. The major cause responsible for this high mortality is associated with the high percentage of oral cancers diagnosed in advanced stages (stages III and IV) where the treatment harbors poor efficacy, resulting in challenges, mutilations, or disability. The main reason for cancer to be diagnosed at an advanced stage is a diagnostic delay, so it is critical to reduce this delay in order to improve the prognosis of patients suffering from oral cancer. The causes of oral cancer diagnostic delay are complex and concern patients, healthcare professionals, and healthcare services. In this manuscript, oral cancer diagnostic delay is critically reviewed based on current evidence, as well as their major causes, main problems, and potential improvement strategies.
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Affiliation(s)
- Isabel González-Ruiz
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Isabel Ruiz-Ávila
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Hospital Universitario San Juan de Reus, CAP Marià Fortuny, 43204 Tarragona, Spain
| | - Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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4
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Revzin MV, Solomon N, Langdon J, Czeyda-Pommersheim F, Menias CO. Delayed cancer diagnosis in the pregnant patient: navigating a complex medical and ethical dilemma. Abdom Radiol (NY) 2023; 48:1599-1604. [PMID: 36951988 DOI: 10.1007/s00261-023-03860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/24/2023]
Abstract
Prompt diagnosis of cancer in pregnancy is necessary to ensure timely management and improve outcomes. However, there are a several reasons why diagnosis may be delayed in pregnancy. Three major contributors to delayed diagnosis and treatment are patient delay, provider delay, and referral delay. This article aims to (1) increase physician awareness of this problem by providing a detailed review of the main culprits of delayed diagnosis and treatment of cancer in the pregnant patient, (2) discuss the complex ethical issues at hand in these cases, and (3) provide suggestions on how to better address such cases with the goal of improving patient outcomes.
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Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA.
| | - Nadia Solomon
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
| | - Jonathan Langdon
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
| | - Ferenc Czeyda-Pommersheim
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
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Challenges in the Early Diagnosis of Oral Cancer, Evidence Gaps and Strategies for Improvement: A Scoping Review of Systematic Reviews. Cancers (Basel) 2022; 14:cancers14194967. [PMID: 36230890 PMCID: PMC9562013 DOI: 10.3390/cancers14194967] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Oral cancer presents a worldwide incidence of 377,713 new cases and 177,757 deaths per year (GLOBOCAN, IARC, WHO). Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of oral malignancies and has a 5-year mortality rate close to 50%. We aim to better understand, based on the evidence, and to discuss in depth, the reasons for the diagnostic delay of oral cancer by reviewing systematic reviews and meta-analyses. We also aim to, identify gaps in evidence, recommend future lines of research that should be implemented, and formulate strategies for improvement. Abstract Oral cancer is a growing problem, accounting for 377,713 worldwide new cases per year, and 177,757 deaths annually and representing a 5-year mortality rate close to 50%, which is a considerable mortality that has not decreased substantially in the last 40 years. The main cause of this high mortality is related to the diagnosis of a high percentage of oral cancers in advanced stages (stages III and IV) in which treatment is complex, mutilating or disabling, and ineffective. The essential cause of a cancer diagnosis at a late stage is the delay in diagnosis, therefore, the achievement of the objective of improving the prognosis of oral cancer involves reducing the delay in its diagnosis. The reasons for the delay in the diagnosis of oral cancer are complex and involve several actors and circumstances—patients, health care providers, and health services. In this paper, we present the results of a scoping review of systematic reviews on the diagnostic delay in oral cancer with the aim to better understand, based on the evidence, and discuss in depth, the reasons for this fact, and to identify evidence gaps and formulate strategies for improvement.
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Momenimovahed Z, Momenimovahed S, Allahqoli L, Salehiniya H. Factors Related to the Delay in Diagnosis of Breast Cancer in the Word: A Systematic Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Garduño-Alanis A, Morales-González L, Ángeles-Llerenas A, Delgado-Ramírez JZ, Ortega-Olvera C, Torres-Mejía G. The effect of the number of biopsies on the delay in the time from the delivery of mammography results to breast cancer histopathological diagnosis. Cancer Causes Control 2022; 33:1355-1361. [PMID: 36029415 DOI: 10.1007/s10552-022-01622-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The delay in the time (in calendar days) from the delivery of mammography results to histopathological breast cancer (BC) diagnosis could be associated with more advanced clinical stages, a worse prognosis and higher mortality. Therefore, we assessed the association between the number of biopsies and the delay in the time (in calendar days) from the delivery of mammography results to histopathological BC. METHODS A survey was performed on 563 women aged between 35 and 69 years with histopathologically confirmed BC who attended 11 Mexican hospitals. RESULTS After adjusting for potential confounders, the odds of having a delay in the time (in calendar days) from the delivery of mammography results to histopathological BC diagnosis (≥ 60 days) among women with ≥ 3 biopsies were 2.99 times the odds of those who had only one biopsy (95% CI 1.35, 6.63). CONCLUSION The number of biopsies should be considered as a predictor of the time delay between the delivery of the mammography result and the diagnostic result.
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Affiliation(s)
- Adriana Garduño-Alanis
- School of Nursing and Obstetrics, Autonomous University of the State of Mexico, Paseo Tollocan s/n, Esquina Jesús Carranza, Col. Moderna de la Cruz, C.P. 50180, Toluca, MEX., Mexico
| | - Lizbeth Morales-González
- Research Department, Universidad de la Salud del Estado de México, Vialidad Toluca Atlacomulco 1946, Col. La Aviación, C.P. 50295, Toluca, MEX., Mexico
| | - Angélica Ángeles-Llerenas
- Center for Population Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - José Zaim Delgado-Ramírez
- Center for Population Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Carolina Ortega-Olvera
- School of Nursing and Nutrition, Autonomous University of San Luis Potosi, Av. Niño Artillero #130, Zona Universitaria, C.P. 78240, San Luis Potosí, Mexico
| | - Gabriela Torres-Mejía
- Center for Population Health Research, Instituto Nacional de Salud Pública, Mexico City, Mexico.
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Gao W, Wang J, Yin S, Geng C, Xu B. An appropriate treatment interval does not affect the prognosis of patients with breast Cancer. HOLISTIC INTEGRATIVE ONCOLOGY 2022; 1:8. [PMID: 37520334 PMCID: PMC9255457 DOI: 10.1007/s44178-022-00010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/09/2022] [Indexed: 12/24/2022]
Abstract
Purpose Major public health emergencies may lead to delays or alterations in the treatment of patients with breast cancer at each stage of diagnosis and treatment. How much do these delays and treatment changes affect treatment outcomes in patients with breast cancer? Methods This review summarized relevant research in the past three decades and identified the effect of delayed treatment on the prognosis of patients with breast cancer in terms of seeking medical treatment, neoadjuvant treatment, surgery, postoperative chemotherapy, radiotherapy, and targeted therapies. Results Delay in seeking medical help for ≥12 weeks affected the prognosis. Surgical treatment within 4 weeks of diagnosis did not affect patient prognosis. Starting neoadjuvant chemotherapy within 8 weeks after diagnosis, receiving surgical treatment at 8 weeks or less after the completion of neoadjuvant chemotherapy, and receiving radiotherapy 8 weeks after surgery did not affect patient prognosis. Delayed chemotherapy did not increase the risk of relapse in patients with luminal A breast cancer. Every 4 weeks of delay in the start of postoperative chemotherapy in patients with luminal B, triple-negative, or HER2-positive breast cancer treated with trastuzumab will adversely affect the prognosis. Targeted treatment delays in patients with HER2-positive breast cancer should not exceed 60 days after surgery or 4 months after diagnosis. Radiotherapy within 8 weeks after surgery did not increase the risk of recurrence in patients with early breast cancer who were not undergoing adjuvant chemotherapy. Conclusion Different treatments have different time sensitivities, and the careful evaluation and management of these delays will be helpful in minimizing the negative effects on patients.
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Affiliation(s)
- Wei Gao
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Jiaxing Wang
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Sifei Yin
- Department of Chemical and Systems Biology, Stanford University, Stanford, California 94305 USA
| | - Cuizhi Geng
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Binghe Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
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Flores-Balcázar CH, Flores-Luna ML, Villarreal-Garza CM, Bargalló-Rocha JE. Provider delay in treatment initiation and its influence on survival outcomes in women with operable breast cancer. Rep Pract Oncol Radiother 2020; 25:271-275. [PMID: 32140085 DOI: 10.1016/j.rpor.2020.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/18/2019] [Accepted: 02/19/2020] [Indexed: 01/03/2023] Open
Abstract
Aim The goal of this study was to determine whether a delay in starting treatment via surgery or neoadjuvant chemotherapy is related to a decrease in cancer-specific survival (CSS) in women with operable breast cancer (BrCr). Background Limited medical infrastructure and a lack of cancer prevention awareness in low- and middle-income countries have caused high BrCr incidence and mortality rates. Methods We analyzed a retrospective cohort of 720 women treated at a single center from 2005 to 2012. CSS estimates were obtained by the Kaplan-Meier method. A Cox model of proportional risks was performed to obtain the risk of dying from BrCr. We also obtained the risk according to the category of treatment initiation. Results Women with locally advanced stages and without hormone receptor expression were more likely to initiate treatment after 45 days. Patients in Stage IIIA had a 78.1% survival if treatment was initiated before 45 days (95% CI, 0.70-0.84) and 63.6% survival if treatment was started after 45 days (95% CI, 0.44-0.78; p < 0.001). Patients in Stage IIIB had a 62.9% survival if treatment was initiated before 45 days (95% CI, 0.53-0.72) and 57.4% survival if treatment started after 45 days (95% CI, 0.31-0.89; p < 0.001). Prognostic factors in which lower survival was recognized were Stage IIIA, Stage IIIB, treatment initiation after 45 days, and triple-negative tumors. Conclusions The initiation of treatment within the first 45 days of diagnosis of BrCr in women portends better survival compared with those who began treatment longer than 45 days from diagnosis.
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Affiliation(s)
- Christian H Flores-Balcázar
- Department of Radiation-Oncology, National Cancer Institute, 22 San Fernando Ave, Section XVI, Tlalpan, Mexico City 14080, Mexico
| | - Ma L Flores-Luna
- Department of Epidemiology, National Institute of Public Health, 50 Fray Pedro de Gante, Section XVI, Tlalpan, Mexico City 14080, Mexico
| | - Cynthia M Villarreal-Garza
- Department of Breast Tumors, National Cancer Institute, 22 San Fernando Ave, Section XVI, Tlalpan, Mexico City 14080, Mexico
| | - Juan E Bargalló-Rocha
- Department of Breast Tumors, National Cancer Institute, 22 San Fernando Ave, Section XVI, Tlalpan, Mexico City 14080, Mexico
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Parker M, Barlow S, Hoe J, Aitken L. Persistent barriers and facilitators to seeking help for a dementia diagnosis: a systematic review of 30 years of the perspectives of carers and people with dementia. Int Psychogeriatr 2020; 32:1-24. [PMID: 32024558 DOI: 10.1017/s1041610219002229] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To identify barriers and facilitators to help seeking for a dementia diagnosis from the perspective of carers and people with dementia. DESIGN A systematic review of the literature was conducted according to the PRISMA guidelines (PROSPERO protocol registration CRD42018092524). Nine electronic databases were searched for qualitative, quantitative, and mixed methods primary research studies. Two independent reviewers screened titles and abstracts, full texts of eligible studies, and conducted quality appraisal of included articles. A convergent qualitative synthesis approach was used. RESULTS From 7496 articles, 35 papers representing 32 studies from 1986 to 2017 were included. Studies originated from 13 countries across 4 continents. Barriers and facilitators were reported predominantly by carers. A small number of studies included people with dementia. Barriers included denial, stigma and fear, lack of knowledge, normalization of symptoms, preserving autonomy, lack of perceived need, unaware of changes, lack of informal network support, carer difficulties, and problems accessing help. Facilitators included recognition of symptoms as a problem, prior knowledge and contacts, and support from informal network. CONCLUSIONS Studies from a 30-year period demonstrated that barriers to help seeking persist globally, despite increasing numbers of national dementia policies. Barriers and facilitators rarely existed independently demonstrating the complexity of help seeking for a diagnosis of dementia. Multiple barriers compounded the decision-making process and more than one facilitator was often required to overcome them. Multi-faceted interventions to reduce barriers are needed, one approach would be a focus on the development of dementia friendly communities to reduce stigma and empower people with dementia and carers.
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Affiliation(s)
| | - Sally Barlow
- Division of Nursing, City, University of London, London, UK
| | - Juanita Hoe
- Division of Nursing, City, University of London, London, UK
| | - Leanne Aitken
- School of Health Sciences, City, University of London, London, UK
- School of Nursing & Midwifery, Griffith University, Queensland, Australia
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11
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Hollander MAG, Greene MG. A conceptual framework for understanding iatrophobia. PATIENT EDUCATION AND COUNSELING 2019; 102:2091-2096. [PMID: 31230872 DOI: 10.1016/j.pec.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 05/07/2019] [Accepted: 06/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Iatrophobia - fear of doctors, medical care, or the medical care system - is common among patients and can negatively impact their health-seeking behaviors and relationships with health care professionals. Despite this, academic literature on iatrophobia often fails to explore its nuanced causes. METHODS We establish a conceptual framework of iatrophobia, categorizing sources of fear that may create barriers to accessing medical care, and recommend a research agenda to address this phenomenon and understand its role in medical care. RESULTS The framework includes three categories of determinants of iatrophobia: patient fear of illness and the medical exam, patient fear of physician reaction, and patient fear related to barriers to care. These categories represent influences from individual to more system-related factors associated with the physician-patient relationship. Research examining iatrophobia should focus on understanding its prevalence, how patients cope with their fear, discussing iatrophobia in the physician-patient encounter, the sociopolitical contribution to iatrophobia, and how iatrophobia can be reduced. CONCLUSIONS Iatrophobia can be categorized into three primary domains, but it remains poorly understood. PRACTICE IMPLICATIONS A more thorough understanding of iatrophobia will help to contextualize its role amid other barriers to care and patient health outcomes.
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Affiliation(s)
- Mara A G Hollander
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Michele G Greene
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, NY, United States
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Zhang H, Wang G, Zhang J, Lu Y, Jiang X. Patient delay and associated factors among Chinese women with breast cancer: A cross-sectional study. Medicine (Baltimore) 2019; 98:e17454. [PMID: 31577773 PMCID: PMC6783180 DOI: 10.1097/md.0000000000017454] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 08/25/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
To examine the current situation of patient delay and to identify factors associated with patient delay among women with breast cancer in China.A total of 283 women, aged 23 to 83 years old and with histologically confirmed breast cancer, were investigated in this cross-sectional study. The women were recruited from seven selected hospitals in Sichuan Province, China. Face-to-face interviews using a structured questionnaire were performed.Among the 283 participants, the range of patient delay was 0.2 to 900 days with a median patient delay of 50 days. A total of 35.8% of patients waited ≥90 days to access medical treatment after symptom onset. Binary logistic regression analysis showed that the main predictors of patient delay were knowledge of breast cancer symptoms (OR = 0.716, 95%CI:0.637-0.804, P = .000), external health locus of control (OR = 1.173, 95%CI:1.087-1.266, P = .000), breast self-examination/physical examination (OR = 0.065, 95%CI: 0.007-0.590, P = .015), perceived health competence (OR = 0.873, 95%CI:0.808-0.944, P = .000), family support (OR = 0.911,95%CI:0.847-0.981, P = .013), pain stimulation (OR = 0.191, 95%CI:0.046-0.792, P = .023) and age (OR = 1.028, 95%CI:1.000-1.058, P = .049).These factors explained 41.0% of the variance.Information on the current situation and predictors of patient delay in Chinese women with breast cancer might provide meaning insights into the early diagnosis of breast cancer. The results of this study may help health professionals develop specific clinical practice strategies to reduce patient delay of initial treatment as a way to improve outcomes for women with breast cancer.
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Affiliation(s)
- Huaguo Zhang
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan
- Henan Medical College, Zhengzhou, Henan
| | - Guorong Wang
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | | | - Ying Lu
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan
| | - Xiaolian Jiang
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan
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Li Y, Zhou Y, Mao F, Guan J, Lin Y, Wang X, Zhang Y, Zhang X, Shen S, Sun Q. The influence on survival of delay in the treatment initiation of screening detected non-symptomatic breast cancer. Sci Rep 2019; 9:10158. [PMID: 31308467 PMCID: PMC6629625 DOI: 10.1038/s41598-019-46736-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/04/2019] [Indexed: 12/14/2022] Open
Abstract
We aimed to determine whether the detection-to-treatment interval of non-symptomatic breast cancer is associated with factors that can predict survival outcomes. A retrospective review of the Breast Surgery Department Database at Peking Union Medical College Hospital (PUMCH) was performed, and a total of 1084 non-symptomatic invasive breast cancer patients were included. The findings revealed that detection-to-treatment interval was significantly longer for women who were older (p = 0.001), lived in rural areas (p = 0.024), had lower education (p = 0.024), and had detection in other institutions (p = 0.006). Other sociodemographic and clinicopathological characteristics were not associated to longer interval. A median follow-up of 35 months (range: 6–60 months) was carried out and a long delay at more than 90 days did not significantly decrease the DFS (univariate, P = 0.232; multivariate, P = 0.088). For triple negative breast cancer, there was a worse DFS if the interval was longer than 90 days both in multivariate analysis (hazard ratio [HR] = 3.40; 95% CI, 1.12–10.35; P = 0.031) and univariate analysis (HR = 2.86; 95% CI, 1.03–7.91; P = 0.042). Further studies on care before initial treatment of non-symptomatic breast cancers are warranted.
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Affiliation(s)
- Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Jinghong Guan
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Xuejing Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Yanna Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Songjie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China.
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Mou J, Bolieu EL, Pflugeisen BM, Amoroso PJ, Devine B, Baldwin LM, Frank LL, Johnson RH. Delay in Treatment After Cancer Diagnosis in Adolescents and Young Adults: Does Facility Transfer Matter? J Adolesc Young Adult Oncol 2019; 8:243-253. [PMID: 30785806 PMCID: PMC6909758 DOI: 10.1089/jayao.2018.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Timeliness is one of the fundamental yet understudied quality metrics of cancer care. Little is known about cancer treatment delay among adolescent and young adult (AYA) cancer patients. This study assessed cancer treatment delay, with a specific focus on facility transfer and diagnosis/treatment interval. Methods: Based on MultiCare Health System's (MHS's) institutional cancer registry data of AYA patients diagnosed during 2006-2015, this study analyzed patient demographics, insurance, clinical characteristics, and time of diagnosis and treatment initiation. Chi-squared tests, cumulative hazard estimates, and Cox proportional regression were used for univariable analysis. Multivariate regression models were used to test the association between care transfer and days of interval or prolonged delay, controlling for baseline parameters. Results: Of 840 analytic AYA cases identified, 457 (54.5%) were both diagnosed and treated within MHS. A total of 45.5% were either diagnosed or treated elsewhere. Mean and median intervals for treatment initiation were 27.03 (95% CI = 21.94-33.14) and 8.00 days (95% CI = 5.00-11.00), respectively, with significant differences between patients with and without facility transfer. Transfer was significantly correlated with longer length of diagnosis-to-treatment interval. Treatment delay, ≥1 week, was associated with transfer, female sex, older age, no surgery involvement, and more treatment modalities. Treatment delay, ≥4 weeks, was associated with transfer, female sex, no insurance, and no surgery involvement. Conclusion: In a community care setting, the diagnosis-to-treatment interval is significantly longer for transferred AYA cancer patients than for patients without a transfer. Future studies are warranted to explore the prognostic implications and the reasons for delays within specific cancer types.
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Affiliation(s)
- Jin Mou
- MultiCare Institute for Research & Innovation, Tacoma, Washington
| | | | | | - Paul J. Amoroso
- MultiCare Institute for Research & Innovation, Tacoma, Washington
| | - Beth Devine
- Department of Health Services, University of Washington, Seattle, Washington
| | - Laura-Mae Baldwin
- Department of Family Medicine, Community Engagement, Institute of Translational Health Sciences, University of Washington, Seattle, Washington
| | - Laura L. Frank
- MultiCare Institute for Research & Innovation, Tacoma, Washington
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Primary health care factors associated with late presentation of cancer in Saudi Arabia. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Delays in the diagnosis of cancer were found to be a worldwide matter, and the early cancer detection has been targeted as a way to improve survival. Quantitative studies from Saudi Arabia reported a high number of cancer cases presenting at cancer centres for the first time with more advanced stages of the disease progression compared to Western countries without exploring the reasons for this phenomenon. Worldwide research identified several factors that contribute to delay in the diagnosis and treatment of cancer which were attributed to both patient and healthcare system. However, it was argued that variation in the operation of health systems and the socio-cultural context across countries makes it difficult to generalise findings beyond individuals’ countries. This necessitates country specific research to investigate why patients in Saudi Arabia present to cancer centres with late/advanced stages of their diseases.Research aim and objectives:The aim of this study is to identify and explore the factors that contribute to late-stage presentation of common cancers in Saudi Arabia. The main objective of this study is to understand the help seeking journey taken by patients with cancer from the time they discovered or felt their symptoms until the time they have their treatment initiated.Methods:Qualitative interviewing was used to collect data from 20 patients and 15 health professionals. The interviews were transcribed and then were subjected to the thematic analysis using a framework approach developed by Ritchie and Spencer (1994).Results:While some findings support what previous studies found as contributing factors responsible for delayed presentation of common cancers, this study identified several factors, which are believed to be country-specific. The ‘role of General Practitioner (GP)’, ‘challenges facing GPs’ and ‘ambiguity of the referral system’ were found to be factors that contribute to delay in the diagnosis and treatment of cancer in Saudi Arabia.Conclusion:This research identified several factors that need to be investigated in the future using quantitative methods. There is a need to investigate the extent of using alternative medicine and its possible association with late presentation of cancer.
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Women's stories of living with breast cancer: A systematic review and meta-synthesis of qualitative evidence. Soc Sci Med 2019; 222:231-245. [PMID: 30665063 DOI: 10.1016/j.socscimed.2019.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/07/2018] [Accepted: 01/13/2019] [Indexed: 02/08/2023]
Abstract
RATIONALE Globally, breast cancer is by far the most frequently occurring cancer amongst women. Whilst the physical consequences of the disease and associated treatments are well documented, a comprehensive picture of how breast cancer is experienced at all stages of disease progression is lacking. OBJECTIVE This systematic review aimed to synthesize qualitative studies documenting women's breast cancer narratives into an empirically based explanatory framework. METHODS Two investigators independently searched Academic Search Premiere, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycARTICLES, PubMed, Science Direct, SCOPUS, Web of Science and three international dissertation repositories using a pre-specified search strategy to identify qualitative studies on women's breast cancer narratives across all geographic and income-level settings. Of the 7840 studies that were screened for eligibility, included in the review were 180 studies, which were assessed using the Critical Appraisal Skills Programme. Using a 'meta-study' approach, an explanatory model of the breast cancer experience was formulated. Finally, we assessed the confidence in the review findings using the 'Confidence in the Evidence from Reviews of Qualitative Research' (CERQual) guidelines. RESULTS Eight core themes were identified: the burden of breast cancer, existential ordeal, illness appraisal, sources of support, being in the healthcare system, the self in relation to others, changes in self-image, and survivor identity. Together, these form the proposed Trajectory of Breast Cancer (TBC) framework. CONCLUSION The Trajectory of Breast Cancer explanatory framework offers a theoretically defensible synthesis of women's experiences of breast cancer. This framework provides an empirical basis for future reviewers conducting qualitative and narrative breast cancer research.
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Lee YH, Kung PT, Wang YH, Kuo WY, Kao SL, Tsai WC. Effect of length of time from diagnosis to treatment on colorectal cancer survival: A population-based study. PLoS One 2019; 14:e0210465. [PMID: 30640932 PMCID: PMC6331126 DOI: 10.1371/journal.pone.0210465] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022] Open
Abstract
Evidence is limited regarding the effect of diagnosis-to-treatment interval (DTI) on the survival of colorectal cancer (CRC) patients. In addition, previous studies on treatment delay and CRC survival have largely grouped patients from all stages (I-IV) into one cohort. Our study provides analysis on each stage individually. We conducted a retrospective cohort study with 39,000 newly diagnosed CRC patients obtained from the Taiwan Cancer Registry Database from 2004–2010 to examine the effect of DTIs on overall survival. DTIs were divided into 3 groups: ≤ 30 days (36,115 patients, 90.5% of study patients), 31–150 days (2,533, 6.4%), and ≥ 151 days (1,252, 3.15%). Risk of death was increased for DTI 31–150 days (hazard ratio 1.51; 95% confidence interval 1.43–1.59) and DTI ≥ 151 days (1.64; 1.54–1.76) compared to DTI ≤ 30. This risk was consistent across all cancer stages. Additional factors that increased risk of death include male gender, age >75, Charlson Comorbidity Index ≥7, other catastrophic illnesses, lack of multidisciplinary team involvement, and treatment in a low volume center. From these results, we advise that the DTI for all CRC patients, regardless of cancer staging, should be 30 days or less.
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Affiliation(s)
- Yung-Heng Lee
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
- Department of Public Health, China Medical University, Taiwan, ROC
- Department of Orthopedics, Miaoli General Hospital, Miaoli, Taiwan, ROC
- Department of Nursing Administration, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.
| | - Yueh-Hsin Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wei-Yin Kuo
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Su-Ling Kao
- Department of Nursing Administration, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, ROC
- Department of Human Resource, Cishan General Hospital, Kaohsiung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
- * E-mail:
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Bonsu AB, Ncama BP. Recognizing and appraising symptoms of breast cancer as a reason for delayed presentation in Ghanaian women: A qualitative study. PLoS One 2019; 14:e0208773. [PMID: 30625156 PMCID: PMC6326484 DOI: 10.1371/journal.pone.0208773] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden of late presentation is well established in women presenting with advanced breast cancer in Africa. This paper aims to explore the reasons for delayed presentation in Ghanaian women with breast cancer. METHOD Eleven (11) women diagnosed with advanced breast cancer were purposively sampled within three years of diagnosis at the palliative care clinic of the Komfo Anokye Teaching Hospital, Ghana. Participation was voluntary. Data was collected through in-depth interviews using a self-devised semi-structured interview guide. The interviews were conducted in "Twi" (local language), audio-tape recorded and covered the women's journey from symptom discovery to their intention to seek help. All audio-taped interviews were transcribed based on the meaning of the respondents' comments. The data was managed using Nvivo version 11 qualitative software. Data was analyzed concurrently with data collection applying the principles of thematic analysis. KEY FINDINGS All the women delayed presentation due to overlapping reasons. Symptom appraisal among the women occurred in two main stages: individual understanding of breast symptom and interactive understanding of the breast symptom. These stages were based on cognitive, psycho-cultural and social factors. The five main themes generated from the data were: symptom experience, knowledge of breast cancer, role of social life and network, coping with a breast symptom and lastly intent to seeking health care. A conceptual model was developed to illustrate the relationships among the key factors and concepts emanated from this study. CONCLUSION Recognition and appraisal of breast cancer symptom in the eleven (11) Ghanaian women interviewed in this study was poor. For instance, a painless breast lump was considered not serious until a sensory symptom appears. This led women to experience appraisal and time point intervals. To minimize the incidence of late presentation of breast cancer cases in Ghana, adequate educational intervention should be provided for Ghanaian women and their social network, and other stakeholders.
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Affiliation(s)
- Adwoa Bemah Bonsu
- Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Busisiwe Purity Ncama
- Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Bolarinwa RA, Olowookere SA, Owojuyigbe TO, Origbo EC, Durosinmi MA. Challenges to Care and Medication Adherence of Patients With Chronic Myeloid Leukemia in a Resource Limited Setting: A Qualitative Study. J Patient Exp 2018; 5:195-200. [PMID: 30214926 PMCID: PMC6134545 DOI: 10.1177/2374373517748641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The factors related to care of patients with chronic myeloid leukemia (CML) often affects treatment outcome. We examined adherence to medication and other challenges to care in our patients on treatment of CML. This qualitative study involved in-depth interviews of 20 patients with CML receiving free imatinib (Glivec) from the Glivec International Patients' Assistance Program. Data collected were thematically analyzed. Findings revealed that despite free drug assistance, there was relative lack of awareness resulting in inappropriate health-seeking behavior. The challenges cut across situations such as poverty, fear of the sustenance of the compassionate drug program, and living far away from the clinic. Forgetfulness was reported as the cause of poor adherence in this study. Suggested solutions include increasing community awareness, ensuring sustainability of the program and establishing more treatment centers nationwide. Strategies such as reminders and patents' support will improve drug adherence among this cohort.
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Affiliation(s)
- R A Bolarinwa
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
| | - S A Olowookere
- Department of Family Medicine, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
| | - T O Owojuyigbe
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
| | - E C Origbo
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
| | - M A Durosinmi
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
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Bhatia RK, Rayne S, Rate W, Bakwenabatsile L, Monare B, Anakwenze C, Dhillon P, Narasimhamurthy M, Dryden-Peterson S, Grover S. Patient Factors Associated With Delays in Obtaining Cancer Care in Botswana. J Glob Oncol 2018; 4:1-13. [PMID: 30199305 PMCID: PMC6223504 DOI: 10.1200/jgo.18.00088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Delays in diagnosis and treatment of cancers can lead to poor survival. These delays represent a multifaceted problem attributable to patient, provider, and systemic factors. We aim to quantify intervals from symptom onset to treatment start among patients with cancer in Botswana and to understand potential risk factors for delay. Patients and Methods From December 2015 to January 2017, we surveyed patients seen in an oncology clinic in Botswana. We calculated proportions of patients who experienced delays in appraisal (between detecting symptoms and perceiving a reason to discuss them with provider, defined as > 1 month), help seeking (between discussing symptoms and first consultation with provider, defined as > 1 month), diagnosis (between first consultation and receiving a diagnosis, defined as > 3 months), and treatment (between diagnosis and starting treatment, defined as > 3 months). Results Among 214 patients with cancer who completed the survey, median age at diagnosis was 46 years, and the most common cancer was cancer of the cervix (42.2%). Eighty-one percent of patients were women, 60.7% were HIV infected, and 56.6% presented with advanced cancer (stage III or IV). Twenty-six percent of patients experienced delays in appraisal, 35.5% experienced delays help seeking, 63.1% experienced delays in diagnosis, and 50.4% experienced delays in treatment. Patient income, education, and age were not associated with delays. In univariable analysis, patients living with larger families were less likely to experience a help-seeking delay (odds ratio [OR], 0.31; P = .03), women and patients with perceived very serious symptoms were less likely to experience an appraisal delay (OR, 0.45; P = .032 and OR, 0.14; P = .02, respectively). Conclusion Nearly all patients surveyed experienced a delay in obtaining cancer care. In a setting where care is provided without charge, cancer type and male sex were more important predictors of delays than socioeconomic factors.
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Affiliation(s)
- Rohini K. Bhatia
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Sarah Rayne
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - William Rate
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Lame Bakwenabatsile
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Barati Monare
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Chidinma Anakwenze
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Preet Dhillon
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Mohan Narasimhamurthy
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Scott Dryden-Peterson
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Surbhi Grover
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
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Murphy PJ, Marlow LAV, Waller J, Vrinten C. What is it about a cancer diagnosis that would worry people? A population-based survey of adults in England. BMC Cancer 2018; 18:86. [PMID: 29361912 PMCID: PMC5781324 DOI: 10.1186/s12885-017-3963-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 12/07/2017] [Indexed: 02/08/2023] Open
Abstract
Background Surveys indicate quite high prevalence of cancer worry in the general population, but little is known about what it is about cancer that worries people. A better understanding of the origins of cancer worry may help elucidate previously found inconsistencies in its behavioural effect on cancer prevention, screening uptake, and help-seeking for symptoms. In this study, we explore the prevalence and population distribution of general cancer worry and worries about specific aspects of cancer previously identified. Methods A population-based survey of 2048 English adults (18–70 years, April–May 2016), using face-to-face interviews to assess demographic characteristics, general cancer worry and twelve sources of cancer worry (adapted from an existing scale), including the emotional, physical, and social consequences of a diagnosis. Results In general, a third of respondents (37%) never worried about cancer, 57% worried occasionally/sometimes, and 6% often/very often. In terms of specific worries, two thirds would be ‘quite a bit’ or ‘extremely’ worried about the threat to life and emotional upset a diagnosis would cause. Half would worry about surgery, radiotherapy, chemotherapy, and loss of control over life. Worries about the social consequences were less commonly anticipated: just under half would worry about financial problems or their social roles, and a quarter would be worried about effects on identity, important relationships, gender role, and sexuality. Women and younger people reported more frequent worry about getting cancer, and would be more worried about the emotional, physical, and social consequences of a cancer diagnosis (p < .001). Those from ethnic minority backgrounds reported less frequent worry about getting cancer than their white counterparts, but would be equally worried about the emotional and physical impact of a cancer diagnosis, and worried more about the social consequences of a cancer diagnosis (p < .05). Conclusions The majority of English adults worry at least occasionally about getting cancer, and would be most worried about the emotional and physical impact of a cancer diagnosis. Distinguishing between the various worries that cancer can evoke may help inform efforts to allay undue worries in those who are deterred by them from engaging with cancer prevention and early detection. Electronic supplementary material The online version of this article (10.1186/s12885-017-3963-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philippa J Murphy
- Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Laura A V Marlow
- Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Jo Waller
- Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Charlotte Vrinten
- Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK.
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Oshiro M, Kamizato M. Patients' help-seeking experiences and delaying in breast cancer diagnosis: A qualitative study. Jpn J Nurs Sci 2018; 15:67-76. [PMID: 28544470 DOI: 10.1111/jjns.12173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/14/2016] [Accepted: 01/05/2017] [Indexed: 11/27/2022]
Abstract
AIM To identify the influencing factors in help-seeking behavior by comparing delayers with non-delayers in Japanese female patients with breast cancer. METHODS This is a descriptive qualitative study. A total of 21 female patients with breast cancer (nine delayers and 12 non-delayers) who were at least 3 months to 5 years postdiagnosis were recruited from two hospitals in Okinawa, Japan. Semistructured interviews were carried out and the results were analyzed by using a qualitative inductive approach. RESULTS The comparison between the delayers and non-delayers showed eight barriers to help-seeking behavior that were unique to the delayers: (i) the appearance of symptoms that cannot be definitely linked to breast cancer; (ii) anxiety and fear; (iii) the necessity to prioritize the immediate needs of daily life; (iv) non-disclosure of the situation; (v) the view that medical care is a nuisance; (vi) a desire to surrender to the natural course of things; (vii) confidence that they would not develop cancer; and (viii) inaccessibility of medical facilities. A common trigger for help-seeking that was identified in both the delayers and the non-delayers was the presence of other persons who encouraged seeking a provider evaluation. CONCLUSION The barriers to help-seeking that were found in this study (namely, the emotional reaction and difficult living conditions) are common worldwide. The Japanese patients with breast cancer in the sample tended to emphasize their relationship with family and friends in their help-seeking behavior, which is a common content in Japanese and other Asian cultures. Therefore, health professionals should assess the social conditions of their patients.
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Affiliation(s)
- Mariko Oshiro
- Department of Nursing, Okinawa Prefectural College of Nursing, Naha, Japan
| | - Midori Kamizato
- Department of Nursing, Okinawa Prefectural College of Nursing, Naha, Japan
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Lewis L, Marcu A, Whitaker K, Maguire R. Patient factors influencing symptom appraisal and subsequent adjustment to oesophageal cancer: A qualitative interview study. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28857296 DOI: 10.1111/ecc.12745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 02/06/2023]
Abstract
Oesophageal cancer (EC) is characterised by vague symptoms and is often diagnosed at an advanced stage, leading to poor outcomes. Therefore, we aimed to investigate whether there might be any patient factors contributing to delay in EC diagnosis, and focused on the symptom appraisal and help-seeking strategies of people diagnosed with EC in the UK. Semi-structured interviews were conducted with 14 patients aged >18 years with localised EC at point of diagnosis. Purposive sampling was used to include patients from 1 to 9 months post-diagnosis. Analysis of the interviews identified three main themes: Interpreting symptoms, Triggers to seeking help and Making sense of an unfamiliar cancer. Findings suggested that participants normalised symptoms or used previous health experiences as a means to interpret their symptoms. The majority of participants were not alarmed by their symptoms, mainly because they had very little knowledge of EC specific symptoms. Lack of knowledge also influenced participants' sense-making of their diagnosis. The findings highlight that the process of symptom appraisal in EC is likely to be inaccurate, which may hinder early presentation and thus diagnosis. Public health campaigns communicating EC specific symptoms, however, could shorten the appraisal period and lead to earlier diagnosis.
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Affiliation(s)
- Liane Lewis
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Afrodita Marcu
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Katriina Whitaker
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Roma Maguire
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
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Gibson F, Pearce S, Fern L, Martins A, Kelly D. Improving the identification of cancer in young people: A scoping review. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23809000.2017.1307089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Akuoko CP, Armah E, Sarpong T, Quansah DY, Amankwaa I, Boateng D. Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa. PLoS One 2017; 12:e0171024. [PMID: 28192444 PMCID: PMC5305236 DOI: 10.1371/journal.pone.0171024] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/13/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Breast cancer (BC) has been described as the leading cause of cancer deaths among women especially in the developing world including sub Saharan Africa (SSA). Delayed presentation and late diagnosis at health facilities are parts of the contributing factors of high BC mortality in Africa. This review aimed to appraise the contributing factors to delayed breast cancer presentation and diagnosis among SSA women. METHODS Five databases encompassing medical and social sciences were systematically searched using predefined search terms linked with breast cancer presentation and diagnosis and sub Saharan Africa. Reference lists of relevant papers were also hand searched. Quality of quantitative and qualitative articles were assessed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Critical Appraisal Skills Programme (CASP) quality appraisal checklist. Thematic analysis was used to synthesize the qualitative studies to integrate findings. RESULTS Fourteen (14) quantitative studies, two (2) qualitative studies and one (1) mixed method study merited inclusion for analysis. This review identified low knowledge of breast cancer among SSA women. This review also found lack of awareness of early detection treatment, poor perception of BC, socio-cultural factors such as belief, traditions and fear as factors impacting African women's health seeking behavior in relation to breast cancer. CONCLUSION Improving African women's knowledge and understanding will improve behaviors related to breast cancer and facilitate early presentation and detection and enhance proper management and treatment of breast cancer.
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Affiliation(s)
| | | | | | - Dan Yedu Quansah
- Graduate School of Public health, Seoul National University, Seoul, South Korea
| | | | - Daniel Boateng
- Julius Global Health, University Medical Center, Utrecht University, the Netherlands
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Marcu A, Black G, Vedsted P, Lyratzopoulos G, Whitaker KL. Educational differences in responses to breast cancer symptoms: A qualitative comparative study. Br J Health Psychol 2017; 22:26-41. [PMID: 27680898 DOI: 10.1111/bjhp.12215] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/12/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Advanced stage at diagnosis for breast cancer is associated with lower socio-economic status (SES). We explored what factors in the patient interval (time from noticing a bodily change to first consultation with a health care professional) may contribute to this inequality. DESIGN Qualitative comparative study. METHODS Semi-structured interviews with a sample of women (≥47 years) from higher (n = 15) and lower (n = 15) educational backgrounds, who had experienced at least one potential breast cancer symptom. Half the participants (n = 15) had sought medical help, half had not (n = 15). Without making breast cancer explicit, we elicited women's sense-making around their symptoms and help-seeking decisions. RESULTS Containment of symptoms and confidence in acting upon symptoms emerged as two broad themes that differentiated lower and higher educational groups. Women from lower educational backgrounds tended to attribute their breast symptoms to trivial factors and were reticent in using the word 'cancer'. Despite 'knowing' that symptoms could be related to cancer, women with lower education invoked lack of medical knowledge - 'I am not a doctor' - to express uncertainty about interpreting symptoms and accessing help. Women with higher education were confident about interpreting symptoms, seeking information online, and seeking medical help. CONCLUSIONS Our findings suggest that knowledge of breast cancer alone may not explain socio-economic differences in how women respond to breast cancer symptoms as women with lower education had 'reasons' not to react. Research is needed on how to overcome a wider spectrum of psycho-social factors to reduce future inequality. Statement of contribution What is already known on this subject? Seven of ten breast cancers in the UK are diagnosed after people contact their doctor with symptoms. Women from lower socio-economic backgrounds are more likely to be diagnosed with advanced disease. There is little evidence related to potential drivers of this SES inequality. What does this study add? We qualitatively explored socio-economic (SES) differences in help-seeking for breast symptoms. Women with higher education were more confident about interpreting symptoms and navigating health care. Women with lower education were more reluctant to seek help due to fear of cancer.
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Affiliation(s)
- Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Georgia Black
- Department of Applied Health Research, University College London, UK
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health, Aarhus University, Denmark
| | - Georgios Lyratzopoulos
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK
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Salih AM, Alfaki MM, Alam-Elhuda DM, Nouradyem MM. Factors Delaying Presentation of Sudanese Breast Cancer Patients: an Analysis Using Andersen's Model. Asian Pac J Cancer Prev 2017; 17:2105-10. [PMID: 27221903 DOI: 10.7314/apjcp.2016.17.4.2105] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE A multicenter, observational, cross-sectional study was conducted to assess factors delaying presentation of breast cancer cases. MATERIALS AND METHODS Data were collected from a pair of highly specialized referral centers, both located in the center of the Sudanese capital, Khartoum. For a total of 153 eligible respondents, durations of delay, clinicodemographic factors and reasons of referral were collected from our respondents through self-administered questionnaires. Logistic regression analysis and ANOVA were used to test the relation between periods of delay and different factors. Odd ratios (OR's) and their correspondent Confidence intervals (95% CI's). Delay periods were studied with Andersen's model. RESULTS The average duration of delay in our study was 11.9 (±11.2) months. Only a quarter of our patients presented early within the first 3 months after onset of their symptoms. About 47.7% arrived later during the course of the first year, while it took beyond that for the last 27% to come. A prior diagnosis of BC was the only predictor of early presentation (for 3-12 months OR=9.6 (<0.00), 95% CI 9.55-9.75; for >12 months OR=9.3 (<0.00), 95% CI 9.33-9.33). Out of the 12 different reasons for delay given by our respondents, none showed a significant difference between patients presenting early or late. Financial incapacity (17.5%), ignorance about BC (14.3), and misinterpreting symptoms (12.7%) were the top three whys of delay. CONCLUSIONS Our findings support existence of a non-uniform pattern of delay among Sudanese BC patients. Changing currently adopted awareness elevating strategies into much more inclusive approaches is strongly recommended.
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Affiliation(s)
- Alaaddin M Salih
- Faculty of Medicine, International University of Africa, Sudan, E-mail :
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Louis CJ, Clark JR, Hillemeier MM, Camacho F, Yao N, Anderson RT. The Effects of Hospital Characteristics on Delays in Breast Cancer Diagnosis in Appalachian Communities: A Population-Based Study. J Rural Health 2017; 34 Suppl 1:s91-s103. [PMID: 28102909 DOI: 10.1111/jrh.12226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/26/2016] [Accepted: 10/27/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Despite being generally accepted that delays in diagnosing breast cancer are of prognostic and psychological concern, the influence of hospital characteristics on such delays remains poorly understood, especially in rural and underserved areas. However, hospital characteristics have been tied to greater efficiency and warrant further investigation as they may have implications for breast cancer care in these areas. METHODS Study data were derived from the Kentucky, North Carolina, Ohio, and Pennsylvania state central cancer registries (2006-2008). We then linked Medicare enrollment files and claims data (2005-2009), the Area Resource File (2006-2008), and the American Hospital Association Annual Survey of Hospitals (2007) to create an integrated data set. Hierarchical linear modeling was used to regress the natural log of breast cancer diagnosis delay on a number of hospital-level, demographic, and clinical characteristics. FINDINGS The baseline study sample consisted of 4,547 breast cancer patients enrolled in Medicare that lived in Appalachian counties at the time of diagnosis. We found that hospitals with for-profit ownership (P < .01) had shorter diagnosis delays than their counterparts. Estimates for comprehensive oncology services, system membership and size were not statistically significant at conventional levels. CONCLUSIONS Some structural characteristics of hospitals (eg, for-profit ownership) in the Appalachian region are associated with having shorter delays in diagnosing breast cancer. Researchers and practitioners must go beyond examining patient-level demographic and tumor characteristics to better understand the drivers of timely cancer diagnosis, especially in rural and underserved areas.
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Affiliation(s)
- Christopher J Louis
- Department of Health Law, Policy and Management, Boston University, Boston, Massachusetts
| | - Jonathan R Clark
- College of Business, The University of Texas at San Antonio, San Antonio, Texas
| | - Marianne M Hillemeier
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Nengliang Yao
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
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29
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Inadequate critical appraisal of studies in systematic reviews of time to diagnosis. J Clin Epidemiol 2016; 78:43-51. [DOI: 10.1016/j.jclinepi.2016.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/02/2016] [Accepted: 03/21/2016] [Indexed: 01/07/2023]
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Dianatinasab M, Fararouei M, Mohammadianpanah M, Zare-Bandamiri M. Impact of social and clinical factors on diagnostic delay of breast cancer: A Cross-sectional Study. Medicine (Baltimore) 2016; 95:e4704. [PMID: 27661018 PMCID: PMC5044888 DOI: 10.1097/md.0000000000004704] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
One of the reasons for high mortality of breast cancer is long delay in seeking medical care. This study was designed to measure the association of a wide range of socio-demographic and clinical factors with the diagnostic delay in breast cancer among Iranian patients.This study was conducted on 505 newly diagnosed patients with breast cancer from southern part of Iran. Medical files of the patients who were admitted to the hospital from November 2013 to May 2015 were examined and clinical and demographic information were extracted.According to the results, illiterate patients were diagnosed on average 87.42 days later compared with those with a college degree (95%CI: 29.68-145.16, P = 0.003) and those from rural area were diagnosed on average 72.48 days later (95%CI: 35.94-109.03, P = 0.001) compared with urban residences. Single women were diagnosed 65.99 days later (95%CI: 7.37-124.61, P = 0.02) compared with those married. Lobular or medullary types of cancer were diagnosed 65.19 days later (95%CI: 2.67-127.70, P = 0.04) compared with ductal type. On the other hand, those who were able to perform breast self-exam were diagnosed 49.07 days earlier compared with others (95%CI: 18.69-79.45, P = 0.002). Those felt lump as the initiating symptom were diagnosed 62.01 days earlier, (95%CI: 8.17-115.85, P = 0.02) compared with those with other initial symptoms. The only factor associated with doctors diagnosis delay was the place of residence as rural residences were diagnosed on average 87.42 days later compared with urban residences, (95%CI: 53.82-121.92, P = 0.001).Higher education, living in cities, ductal type of tumor, and noticing lump in breast were the most important demographic and clinical factors associated with shorter breast cancer diagnosis delay. Informing women and doctors, especially general physicians who are practicing in rural areas, of the common symptoms of breast cancer as well as training women to perform breast self-examination are effective measures in reducing breast cancer diagnosis delay. Providing accessible and effective diagnosis services to rural women reduces diagnosis delay in rural patients.
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Affiliation(s)
- Mostafa Dianatinasab
- Student Research Committee, Department of Epidemiology, School of Health
- HIV/AIDS Research Center
| | - Mohammad Fararouei
- HIV/AIDS Research Center
- Correspondence: Mohammad Fararouei HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran (e-mail: )
| | | | - Mohammad Zare-Bandamiri
- Department of Epidemiology, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Tejeda S, Gallardo RI, Ferrans CE, Rauscher GH. Breast cancer delay in Latinas: the role of cultural beliefs and acculturation. J Behav Med 2016; 40:343-351. [PMID: 27572092 DOI: 10.1007/s10865-016-9789-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/22/2016] [Indexed: 01/07/2023]
Abstract
Cultural beliefs about breast cancer may act as a barrier to Latina women seeking preventive services or timely follow-up for breast symptoms regardless of access. This study examines the association between factors and breast cancer cultural beliefs and the extent to which cultural beliefs are associated with delays in breast cancer care. Participants who were Latina, ages 30-79, and had been diagnosed with a primary breast cancer were examined (n = 181). Interviews included a 15-item cultural beliefs scale spanning beliefs inconsistent with motivation to seek timely healthcare. Self-reported date of symptom discovery, date of first medical presentation, and date of first treatment were used to construct measures of prolonged patient, clinical, and total delay. Logistic regression with model-based standardization was used to estimate crude and confounder-adjusted prevalence differences for prolonged delay by number of cultural beliefs held. Women held a mean score of three cultural beliefs. The belief most commonly held was, "Faith in God can protect you from breast cancer" (48 %). Holding three or more cultural beliefs was associated with lower acculturation, lower socioeconomic status and less access to care (p < 0.01). After adjusting for age, education, income, acculturation, trust, and insurance, likelihood of prolonged total delay remained 21 percentage points higher in women who held a higher number cultural beliefs (p = 0.02). Cultural beliefs may predispose Latina women to prolong delays in seeking diagnosis and treatment for breast symptoms. Cultural beliefs represent a potential point of intervention to decrease delays among Latina breast cancer patients.
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Affiliation(s)
- Silvia Tejeda
- School of Public Health, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Rani I Gallardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Carol Estwing Ferrans
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street (M/C 923), Chicago, IL, 60612, USA.
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Bogart LM. The Relationship of Stereotypes about Helpers to Help-Seeking Judgments, Preferences, and Behaviors. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2016. [DOI: 10.1177/01461672982412002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the relationship of two conceptually distinct components of stereotypes (perceived group stereo typicality and perceived group dispersion) to judgments and help-seeking behavior Eighty-six participants had an opportunity to request help on a math test from either an Asian American or a White American male target. Participants who perceived Asian Americans more stereotypically as a group relative to White Americans judged the Asian American target in a more stereotypic manner and requested more help from him than from the White American target. Participants who perceived Asian Americans to be more dispersed as a group relative to White Americans were less confident in their judgments and took longer to make help-seeking decisions. These results extend previous work by demonstrating that perceived stereo typicality and perceived dispersion are conceptually distinct components of stereotypes that not only have different relationships with judgments but also with behaviors.
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McLachlan S, Mansell G, Sanders T, Yardley S, van der Windt D, Brindle L, Chew-Graham C, Little P. Symptom perceptions and help-seeking behaviour prior to lung and colorectal cancer diagnoses: a qualitative study. Fam Pract 2015; 32:568-77. [PMID: 26099812 PMCID: PMC4576759 DOI: 10.1093/fampra/cmv048] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lung and colorectal cancer are common and have high UK mortality rates. Early diagnosis is important in reducing cancer mortality, but the literature on lung and colorectal cancers suggests many people wait for a considerable time before presenting symptoms. OBJECTIVE To gain in-depth understanding of patients' interpretations of symptoms of lung and colorectal cancer prior to diagnosis, and to explore processes leading to help-seeking. METHODS Semi-structured interviews were conducted with patients diagnosed with lung (N=9) or colorectal (N=20) cancer within the previous 12 months. Patients were asked about symptoms experienced in the period preceding diagnosis, their interpretations of symptoms, and decision making for help-seeking. Thematic analysis was conducted and comparisons drawn within and across the patient groups. RESULTS Patients were proactive and rational in addressing symptoms; many developed alternative, non-cancer explanations based on their knowledge and experience. Discussions with important others frequently provided the impetus to consult, but paradoxically others often initially reinforced alternative explanations. Fear and denial did not emerge as barriers to help-seeking, but help-seeking was triggered when patients' alternative explanations could no longer be maintained, for instance due to persistence or progression of symptoms. CONCLUSION Patients' reasoning, decision making and interpersonal interactions prior to diagnosis were complex. Prompting patients for additional detail on symptoms within consultations could elicit critical contextual information to aid referral decisions. Findings also have implications for the design of public health campaigns.
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Affiliation(s)
- Sarah McLachlan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire,
| | - Gemma Mansell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire
| | - Tom Sanders
- NIHR CLAHRC Yorkshire and Humber, Section of Public Health, School of Health and Related Research, University of Sheffield, Sheffield
| | - Sarah Yardley
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, Central and North West London NHS Foundation Trust, London
| | - Daniëlle van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire
| | | | - Carolyn Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
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Tiwari V, Yogi V, Ghori HU, Singh OP, Peepre K, Yadav S, Mohare C. Identifying the Factors Causing Delayed Presentation of Cancer Patients to a Government Medical College of Central India. J Clin Diagn Res 2015; 9:XC09-XC12. [PMID: 26500996 DOI: 10.7860/jcdr/2015/15104.6512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/31/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of cancer is increasing throughout the world. One of the prime aims of its management is early diagnosis and therapeutic intervention. Factors causing delay to either of these goals should be identified and rectified. AIM To identify the factors causing delayed initial diagnosis and subsequent management in patients presenting to the Oncology department. MATERIALS AND METHODS Three hundred proven cancer patients were prospectively evaluated for the pattern of presentation to the outpatient Department of Radiation Oncology of a Government Medical College (MC) in Central India. RESULTS The mean age of presentation was 51.05 years (range 7 months-77 years). The number of male patients was 168 while females were 132. The duration of symptoms ranged from 20 days to 3 years. The number of patients with little/no education presented mainly in advanced stages as compared to their educated counterpart and this difference was statistically significant (p<0.001). The number of patients presenting directly to the department was 108, those diagnosed outside and referred to us was 84 while those diagnosed and received some form of oncologic treatment outside and referred thereafter was 108. The difference in the primary delay between patients presenting directly to the MC versus those diagnosed outside was significant (p=0.0126). The mean duration of starting definitive treatment after presentation to the outpatient was 4.68 days (range 0-22 days) and was very significantly (p< 0.001) less than the secondary delays caused to the other two subsets of patients. CONCLUSION Factors causing delayed presentation are both patient and system related. It is imperative to educate the common people regarding the early signs and symptoms of cancer. At the same time, the system needs to overhaul its efficiency to avoid secondary delays that adversely affect the treatment outcome. An upgradation of the existing oncology facilities in the public sector can achieve this target efficiently.
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Affiliation(s)
- Vivek Tiwari
- Assistant Professor, Department of Radiation Oncology, Gandhi Medical College , Bhopal, India
| | - Veenita Yogi
- Assistant Professor, Department of Radiation Oncology, Gandhi Medical College , Bhopal, India
| | - Hameed Uzzafar Ghori
- Associate Professor, Department of Radiation Oncology, Gandhi Medical College , Bhopal, India
| | - Om Prakash Singh
- Professor and Head, Department of Radiation Oncology, Gandhi Medical College , Bhopal, India
| | - Karan Peepre
- Professor, Department of Radiation Oncology, Gandhi Medical College , Bhopal, India
| | - Suresh Yadav
- Medical Physicist, Department of Radiation Oncology, Gandhi Medical College , Bhopal, India
| | - Chaitlal Mohare
- Scientific Officer, Department of Radiation Oncology, Gandhi Medical College , Bhopal, India
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Khakbazan Z, Taghipour A, Roudsari RL, Mohammadi E, Omranipour R. Delayed presentation of self-discovered breast cancer symptoms in Iranian women: a qualitative study. Asian Pac J Cancer Prev 2015; 15:9427-32. [PMID: 25422236 DOI: 10.7314/apjcp.2014.15.21.9427] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delayed presentation of symptomatic breast cancer is a public health issue in Iran, making a major contribution to low survival. Despite the importance of this problem, current knowledge is insufficient to inform interventions to shorten patient delay. The aim of this study was to explore factors influencing patient delay in Iranian women with self-discovered breast cancer symptom. MATERIALS AND METHODS This qualitative study was conducted during 2012-2013. Purposeful sampling was used to recruit 20 Iranian women with self-discovered symptoms of breast cancer who attended the Cancer Institute of Tehran University of Medical Sciences, Tehran, Iran. Data were collected through semi-structured in-depth audiotaped interviews, which were transcribed and analyzed using conventional content analysis with MAXqda software version 10. FINDINGS Content analysis of the data revealed four main themes related to the delay in seeking medical help including: 1) attributing symptoms to the benign conditions; 2) conditional health behavior; 3) inhibiting emotional expression; and 4) barriers to access to health care systems. CONCLUSIONS These results suggest that patient delay is influenced by complex and multiple factors. Effective intervention to reduce patient delay for breast cancer should be developed by focusing on improvement of women's medical knowledge, managing patients' emotional expression and reform of the referral system.
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Affiliation(s)
- Zohreh Khakbazan
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran E-mail :
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Singer S, Blettner M, Kreienberg R, Janni W, Wöckel A, Kühn T, Felberbaum R, Flock F, Schwentner L. Breast Cancer Patients' Fear of Treatment: Results from the Multicenter Longitudinal Study BRENDA II. Breast Care (Basel) 2015. [PMID: 26195937 DOI: 10.1159/000381933] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fear of cancer treatment can become overwhelming. It is important to understand what patients are mainly afraid of and what factors are correlated with intense fear of treatment. METHODS Patients with primary breast cancer (n = 761) completed questionnaires about fear of treatment before surgery (t1), and before (t2) and after (t3) adjuvant treatment. Psychological comorbidity was assessed using the Patient Health Questionnaire. Logistic regression identified predictors of intense fear of treatment. RESULTS Patients were most afraid of chemotherapy (mean score 3.5), and fear remained high throughout follow-up; fear of radiotherapy and of surgery was lower and decreased over time (from 2.7 to 2.2, p < 0.0001; and from 2.6 to 2.2, p < 0.0001, respectively). Patients with psychological co-morbidity (odds ratios (OR) 1.7-3.0) and those who had heard reports of negative experiences with cancer treatments from others (OR 3.8-16.2) were more likely to have intense fear of all the treatments. Patients with a previous cancer less often expressed fear of surgery (OR 0.6, 95% confidence interval 0.4-1.0). CONCLUSION Fear of treatment, especially of chemotherapy, is prevalent in many patients with primary breast cancer. Patients with psychological co-morbidity and those who have heard reports of negative experiences with cancer treatment are at higher risk of experiencing intense fear.
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Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Germany
| | - Rolf Kreienberg
- Department of Gynaecology and Obstetrics, University of Ulm, Germany
| | - Wolfgang Janni
- Department of Gynaecology and Obstetrics, University of Ulm, Germany
| | - Achim Wöckel
- Department of Gynaecology and Obstetrics, University of Würzburg, Germany
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Hospital Esslingen, Germany
| | | | - Felix Flock
- Department of Gynaecology and Obstetrics, Hospital Memmingen, Germany
| | - Lukas Schwentner
- Department of Gynaecology and Obstetrics, University of Ulm, Germany
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Low EL, Whitaker KL, Simon AE, Sekhon M, Waller J. Women's interpretation of and responses to potential gynaecological cancer symptoms: a qualitative interview study. BMJ Open 2015; 5:e008082. [PMID: 26150145 PMCID: PMC4499727 DOI: 10.1136/bmjopen-2015-008082] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To explore women's experiences of symptoms potentially indicative of gynaecological cancer in a community-based sample without imposing a cancer perspective. DESIGN A qualitative interview study with thematic analysis of transcripts. PARTICIPANTS 26 women aged ≥30 years, who had experienced a symptom that might indicate gynaecological cancer in the past 3 months, were recruited using a screening questionnaire distributed online and in community settings. SETTING London, UK. RESULTS Women attributed gynaecological symptoms to existing illnesses/conditions or considered themselves to be predisposed to them, either through their 'genes' or previous personal experience. Normalising symptoms by attributing them to demographic characteristics (eg, age, sex) was common, as was considering them a side effect of hormonal contraception. When women raised cancer as a possible cause, they often dismissed it as unlikely. Responses to symptoms included self-management (eg, self-medicating, making lifestyle changes), adopting a 'lay system of care', or consulting a healthcare professional. Triggers to help-seeking included persistent, painful or debilitating symptoms, concern about symptom seriousness, and feeling that help-seeking was legitimised. Barriers to help-seeking included lack of concern, vague symptoms, unusual symptom location, competing time demands, previous negative experiences with the healthcare system, and not wanting to be perceived as a time-waster. CONCLUSIONS Attributions of symptoms potentially indicative of a gynaecological cancer were varied, but most often involved women fitting symptoms into their expectations of what was 'normal'. Normalising acted as a barrier to seeking help from a healthcare professional, alongside competing time demands and negative attitudes towards help-seeking. These barriers may lead to later diagnosis and poorer cancer survival. Our findings could be used to inform the development of interventions to encourage appropriate help-seeking.
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Affiliation(s)
- E L Low
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London (UCL), London, UK
| | - K L Whitaker
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - A E Simon
- Centre for Health Services Research, City University, London, UK
| | - M Sekhon
- Centre for Health Services Research, City University, London, UK
| | - J Waller
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London (UCL), London, UK
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Beach WA, Dozier DM. Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors' Responses During Oncology Interviews. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1243-54. [PMID: 26134261 PMCID: PMC5114848 DOI: 10.1080/10810730.2015.1018644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A subsampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists. Patients completed pre/post self-report measures about fears, uncertainties, and hopes as well as postevaluations of interview satisfaction. Conversation analysis was used to initially identify pairs of patient-initiated and doctor-responsive actions. A coding scheme was subsequently developed, and two independent coding teams, comprised of two coders each, reliably identified patient-initiated and doctor-responsive social actions. Interactional findings reveal that new cancer patients initiate actions much more frequently than previous research had identified, concerns are usually raised indirectly, and with minimal emotion. Doctors tend to respond to these concerns immediately, but with even less affect, and rarely partner with patients. From pre/post results, it was determined that the higher patients' reported fears, the higher their postvisit fears and lower their satisfaction. Patients with high uncertainty were highly proactive (e.g., asked more questions), yet reported even greater uncertainties after encounters. Hopeful patients also exited interviews with high hopes. Overall, new patients were very satisfied: oncology interviews significantly decreased patients' fears and uncertainties, while increasing hopes. Discussion raises key issues for improving communication and managing quality cancer care.
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Affiliation(s)
- Wayne A. Beach
- Professor, School of Communication, San Diego State University, San Diego, CA 92182-4561, Phone: (619) 594-4948, FAX: (619) 594-0704, Adjunct Professor, Department of Surgery, Member, Moores Cancer Center, University of California, San Diego
| | - David M. Dozier
- Professor, Public Relations Emphasis, School of Journalism & Media Studies, San Diego State University, San Diego, CA 92182-4561
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Khakbazan Z, Roudsari RL, Taghipour A, Mohammadi E, Pour RO. Appraisal of breast cancer symptoms by Iranian women: entangled cognitive, emotional and socio-cultural responses. Asian Pac J Cancer Prev 2015; 15:8135-42. [PMID: 25338996 DOI: 10.7314/apjcp.2014.15.19.8135] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. MATERIALS AND METHODS A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. RESULTS The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. CONCLUSIONS This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.
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Affiliation(s)
- Zohreh Khakbazan
- Department of Midwifery, Cancer Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran E-mail :
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Al-Amri AM. Clinical presentation and causes of the delayed diagnosis of breast cancer in patients with pregnancy associated breast cancer. J Family Community Med 2015; 22:96-100. [PMID: 25983605 PMCID: PMC4415134 DOI: 10.4103/2230-8229.155383] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The objective was to assess the clinical presentation, delay of diagnosis, and the causes of delay in the diagnosis of patients with pregnancy-associated breast cancer (PABC) and patients with non-PABC. PATIENTS AND METHODS This was a face-to-face interview with women who had histologically confirmed BC. All respondents were interviewed at our hospital. RESULTS We interviewed 56 patients, 36 with non-PABC and 20 with PABC. Of the 20 patients with PABC, BC was diagnosed in 12 (60%) during pregnancy and 8 (40%) during postpartum. 18 of the patients (90%) with PABC presented mainly with a mass 3 (15%) with pain and ulcer, 5 (25%) with skin redness and thickening, 6 (30%) with nipple retraction and 4 (20%) with discharge 12 (60%) patients with PABC had delayed diagnosis and 8 (40%) of this delay was due to physicians' reassurance, and 2 (10%) because of fear of cancer. Similarly, 35 (97%) patients with non-PABC presented with breast mass, 3 (8.3%) with infrequent pain 4 (11.11%) with inflammation 2 (5.55%) with ulcer 2 (5.55%) with nipple discharge and4 (11.11%) with thickening of the skin compared with PABC patients. Only 4 (11.11%) in non-PABC had delayed diagnosis, and for half of them the delay was due to the fear of cancer. Two patients with PABC and non-PABC were afraid of cancer 16.66% and 5.55%, respectively. However, 8 (60%) of patients with PABC had delayed diagnosis compared to 0% of patients with non-PABC. CONCLUSION In this study, the majority of patients with PABC or non-PABC presented with a breast lump. Other symptoms were more common in patients with PABC than in patients with non-PABC. An increased awareness of clinicians may help reduce delay in the diagnosis of patients with PABC.
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Affiliation(s)
- Ali M Al-Amri
- Department of Internal Medicine and Oncology, College of Medicine, University of Dammam, King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia
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Balasooriya-Smeekens C, Walter FM, Scott S. The role of emotions in time to presentation for symptoms suggestive of cancer: a systematic literature review of quantitative studies. Psychooncology 2015; 24:1594-604. [PMID: 25989295 DOI: 10.1002/pon.3833] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/30/2015] [Accepted: 04/03/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Emotions may be important in patients' decisions to seek medical help for symptoms suggestive of cancer. OBJECTIVES The aim of this systematic literature review was to examine quantitative literature on the influence of emotion on patients' help-seeking for symptoms suggestive of cancer. The objectives were to identify the following: (a) which types of emotions influence help-seeking behaviour, (b) whether these form a barrier or trigger for seeking medical help and (c) how the role of emotions varies between different cancers and populations. METHODS We searched four electronic databases and conducted a narrative synthesis. Inclusion criteria were studies that reported primary, quantitative research that examined any emotion specific to symptom appraisal or help-seeking for symptoms suggestive of cancer. RESULTS Thirty-three papers were included. The studies were heterogeneous in their methods and quality, and very few had emotion as the main focus of the research. Studies reported a limited range of emotions, mainly related to fear and worry. The impact of emotions appears mixed, sometimes acting as a barrier to consultation whilst at other times being a trigger or being unrelated to time to presentation. It is plausible that different emotions play different roles at different times prior to presentation. CONCLUSIONS This systematic review provides some quantitative evidence for the role of emotions in help-seeking behaviour. However, it also highlighted widespread methodological, definition and design issues among the existing literature. The conflicting results around the role of emotions on time to presentation may be due to the lack of definition of each specific emotion.
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Affiliation(s)
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Suzanne Scott
- Unit of Social and Behavioural Sciences, King's College London Dental Institute, London, UK
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Mathews M, Ryan D, Bulman D. Patient-expressed perceptions of wait-time causes and wait-related satisfaction. ACTA ACUST UNITED AC 2015; 22:105-12. [PMID: 25908909 DOI: 10.3747/co.22.2243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study set out to identify patterns in the causes of waits and wait-related satisfaction. METHODS We conducted qualitative interviews with urban, semi-urban, and rural patients (n = 60) to explore their perceptions of the waits they experienced in the detection and treatment of their breast, prostate, lung, or colorectal cancer. We asked participants to describe their experiences from the onset of symptoms to the start of treatment at the cancer clinic and their satisfaction with waits at various intervals. Interview transcripts were coded using a thematic approach. RESULTS Patients identified five groups of wait-time causes: Patient-related (beliefs, preferences, and non-cancer health issues)Treatment-related (natural consequences of treatment)System-related (the organization or functioning of groups, workforce, institution, or infrastructure in the health care system)Physician-related (a single physician responsible for a specific element in the patient's care)Other causes (disruptions to normal operations of a city or community as a whole) With the limited exception of physician-related absences, the nature of the cause was not linked to overall satisfaction or dissatisfaction with waits. CONCLUSIONS Causes in themselves do not explain wait-related satisfaction. Further work is needed to explore the underlying reasons for wait-related satisfaction or dissatisfaction. Although our findings shed light on patient experiences with the health system and identify where interventions could help to inform the expectations of patients and the public with respect to wait time, more research is needed to understand wait-related satisfaction among cancer patients.
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Affiliation(s)
- M Mathews
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL
| | - D Ryan
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL
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Palmer NRA, Weaver KE, Hauser SP, Lawrence JA, Talton J, Case LD, Geiger AM. Disparities in barriers to follow-up care between African American and White breast cancer survivors. Support Care Cancer 2015; 23:3201-9. [PMID: 25821145 DOI: 10.1007/s00520-015-2706-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/16/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Despite recommendations for breast cancer survivorship care, African American women are less likely to receive appropriate follow-up care, which is concerning due to their higher mortality rates. This study describes differences in barriers to follow-up care between African American and White breast cancer survivors. METHODS We conducted a mailed survey of women treated for non-metastatic breast cancer in 2009-2011, 6-24 months post-treatment (N = 203). Survivors were asked about 14 potential barriers to follow-up care. We used logistic regression to explore associations between barriers and race, adjusting for covariates. RESULTS Our participants included 31 African American and 160 White survivors. At least one barrier to follow-up care was reported by 62 %. Compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p = 0.01), other health care costs (21.3 vs. 45.2 %, p = 0.01), anxiety/worry (29.4 vs. 51.6 %, p = 0.02), and transportation (4.4 vs. 16.1 %, p = 0.03). After adjustment for covariates, African Americans were three times as likely to report at least one barrier to care (odds ratio (OR) = 3.3, 95 % confidence interval (CI) = 1.1-10.1). CONCLUSIONS Barriers to care are common among breast cancer survivors, especially African American women. Financial barriers to care may prevent minority and underserved survivors from accessing follow-up care. Enhancing insurance coverage or addressing out-of-pocket costs may help address financial barriers to follow-up care among breast cancer survivors. Psychosocial care aimed at reducing fear of recurrence may also be important to improve access among African American breast cancer survivors.
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Affiliation(s)
- Nynikka R A Palmer
- Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
| | - Kathryn E Weaver
- Social Science and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sally P Hauser
- General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Julia A Lawrence
- General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Jennifer Talton
- Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - L Douglas Case
- Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ann M Geiger
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Carter-Harris L, Hermann CP, Schreiber J, Weaver MT, Rawl SM. Lung cancer stigma predicts timing of medical help-seeking behavior. Oncol Nurs Forum 2014; 41:E203-10. [PMID: 24769603 DOI: 10.1188/14.onf.e203-e210] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine relationships among demographic variables, healthcare system distrust, lung cancer stigma, smoking status, and timing of medical help-seeking behavior in individuals with symptoms suggestive of lung cancer after controlling for ethnicity, socioeconomic status, and social desirability. DESIGN Descriptive, cross-sectional, correlational study. SETTING Outpatient oncology clinics in Louisville, KY. SAMPLE 94 patients diagnosed in the past three weeks to six years with all stages of lung cancer. METHODS Self-report, written survey packets were administered in person followed by a semistructured interview to assess symptoms and timing characteristics of practice-identified patients with lung cancer. MAIN RESEARCH VARIABLES Timing of medical help-seeking behavior, healthcare system distrust, lung cancer stigma, and smoking status. FINDINGS Lung cancer stigma was independently associated with timing of medical help-seeking behavior in patients with lung cancer. Healthcare system distrust and smoking status were not independently associated with timing of medical help-seeking behavior. CONCLUSIONS FINDINGS suggest that stigma influences medical help-seeking behavior for lung cancer symptoms, serving as a barrier to prompt medical help-seeking behavior. IMPLICATIONS FOR NURSING When designing interventions to promote early medical help-seeking behavior in individuals with symptoms suggestive of lung cancer, methods that consider lung cancer stigma as a barrier that can be addressed through public awareness and patient-targeted interventions should be included.
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Khakbazan Z, Taghipour A, Latifnejad Roudsari R, Mohammadi E. Help seeking behavior of women with self-discovered breast cancer symptoms: a meta-ethnographic synthesis of patient delay. PLoS One 2014; 9:e110262. [PMID: 25470732 PMCID: PMC4254513 DOI: 10.1371/journal.pone.0110262] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 09/16/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Patient delay makes a critical contribution to late diagnosis and poor survival in cases of breast cancer. Identifying the factors that influence patient delay could provide information for adopting strategies that shorten this delay. The aim of this meta-ethnography was to synthesize existing qualitative evidence in order to gain a new understanding of help seeking behavior in women with self-discovered breast cancer symptoms and to determine the factors that influence patient delay. METHODS The design was a meta-ethnography approach. A systematic search of the articles was performed in different databases including Elsevier, PubMed, ProQuest and SCOPUS. Qualitative studies with a focus on help seeking behaviors in women with self-discovered breast cancer symptoms and patient delay, published in the English language between 1990 and 2013 were included. The quality appraisal of the articles was carried out using the Critical Appraisal Skills Programme qualitative research checklist and 13 articles met the inclusion criteria. The synthesis was conducted according to Noblit and Hare's meta-ethnographic approach (1988), through reciprocal translational analysis and lines-of-argument. FINDINGS The synthesis led to identification of eight repeated key concepts including: symptom detection, initial symptom interpretation, symptom monitoring, social interaction, emotional reaction, priority of medical help, appraisal of health services and personal-environmental factors. Symptom interpretation is identified as the important step of the help seeking process and which changed across the process through active monitoring of their symptoms, social interactions and emotional reactions. The perceived seriousness of the situation, priority to receive medical attention, perceived inaccessibility and unacceptability of the health care system influenced women's decision-making about utilizing health services. CONCLUSION Help seeking processes are influenced by multiple factors. Educational programs aimed at correcting misunderstandings, erroneous social beliefs and improving self-awareness could provide key strategies to improve health policy which would reduce patient delay.
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Affiliation(s)
- Zohreh Khakbazan
- School of Nursing and Midwifery, Mashhad University of medical science, Mashhad, Iran
| | - Ali Taghipour
- Health Sciences Research Center, Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Evidence-Based Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eesa Mohammadi
- Medical Sciences Faculty, Nursing Department, Tarbiat Modares University, Tehran, Iran
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Memon ZA, Shaikh AN, Rizwan S, Sardar MB. Reasons for patient's delay in diagnosis of breast carcinoma in Pakistan. Asian Pac J Cancer Prev 2014; 14:7409-14. [PMID: 24460311 DOI: 10.7314/apjcp.2013.14.12.7409] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delay in diagnosis of breast cancer is associated with a poorer survival and a pivotal contribution to this delayed diagnosis comes from patient delay in presenting at a clinic. Reasons involved must be evaluated in order to decrease this reducible delay. OBJECTIVES i) To evaluate the reasons for patient delay in diagnosis of breast cancer; ii) to investigate any association with other variables. MATERIALS AND METHODS A 6 month cross sectional study (from July 2012 to Dec 2012), was carried out in Surgical and Oncology Units of Civil Hospital, Karachi. A total of 100 females diagnosed with breast cancer of any histological type were interviewed after informed consent and relevant data were collected. Due ethical clearance was obtained. RESULTS Mean age was 47.5±12.1 years with a range from 25-77 years. Mean duration of delay was 5.13±4.8 months, from shortest 1 month to longest 36 months. Duration of delay was observed to be no delay (<1 month) in 28%, short delay (1-3 months) in 30% and long delay (>3 months) in 42% of patients. Considering the symptoms as "harmless" (39%) was the most frequent reason of delay followed by "temporary" (20%) and the "use of traditional methods" (12%). Most common reason for later approaches was an increase in the size of the lump (41%). Statistically significant association (p-value <0.05) of longer patient delay was obtained with being single, being illiterate, painless breast lump as the first symptom, negative family history of breast cancer and vague attribution of the symptoms. CONCLUSIONS Significant delay in approach to health care facility was observed in our study due to variable reasons given by women. Sufficient awareness regarding breast cancer, its symptoms and favorable effects of a timely diagnosis on prognosis must be imparted to our general population.
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Dobson CM, Russell AJ, Rubin GP. Patient delay in cancer diagnosis: what do we really mean and can we be more specific? BMC Health Serv Res 2014; 14:387. [PMID: 25217105 PMCID: PMC4175269 DOI: 10.1186/1472-6963-14-387] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/08/2014] [Indexed: 01/07/2023] Open
Abstract
Background Early diagnosis is a key focus of cancer control because of its association with survival. Delays in diagnosis can occur throughout the diagnostic pathway, within any one of its three component intervals: the patient interval, the primary care interval and the secondary care interval. Discussion A key focus for help-seeking research in patients with symptoms of cancer has been the concept of ‘delay’. The literature is plagued by definitional and semantic problems, which serve to hinder comparison between studies. Use of the word ‘delay’ has been criticised as judgemental and potentially stigmatising, because of its implications of intent. However, the suggested alternatives (time to presentation, appraisal interval, help-seeking interval and postponement of help-seeking) still fail to accurately define the concept in hand, and often conflate three quite separate ideas; that of an interval, that of an unacceptably long interval, and that of a specific event which caused delay in the diagnostic process. We discuss the need to disentangle current terminology and suggest the term ‘prolonged interval’ as a more appropriate alternative. Most studies treat the patient interval as a dichotomous variable, with cases beyond a specified time point classified as ‘delay’. However, there are inconsistencies in both where this line is drawn, ranging from one week to three months, and how, with some studies imposing seemingly arbitrary time points, others utilising the median as a divisive tool or exploring quartiles within their data. This not only makes comparison problematic, but, as many studies do not differentiate between cancer site, also imposes boundaries which are not necessarily site-relevant. We argue that analysis of the patient interval should be based on presenting symptom, as opposed to pathology, to better reflect the context of the help-seeking interval, and suggest how new definitional boundaries could be developed. Summary The word ‘delay’ is currently (conf)used to describe diverse conceptualisations of ‘delay’ and more mindful, and discerning language needs to be developed to enable a more sophisticated discussion. By stratifying help-seeking by presenting symptom(s), more accurate and informative analyses could be produced which, in turn, would result in more accurately targeted early diagnosis interventions.
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Huo Q, Cai C, Zhang Y, Kong X, Jiang L, Ma T, Zhang N, Yang Q. Delay in diagnosis and treatment of symptomatic breast cancer in China. Ann Surg Oncol 2014; 22:883-8. [PMID: 25212834 DOI: 10.1245/s10434-014-4076-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Delay in diagnosis and treatment of cancer may lead to advanced tumor characteristics and poor prognosis. Research and investigation from economically developing countries such as China are warranted to support these conclusions, so we studied the impact on prognosis of delays and factors predicting delay in symptomatic breast cancer patients in China. METHODS Medical records and follow-up information were collected. Variables including demographic data, and clinical and tumor characteristics, including patient age, menstrual status, residential status, initial symptom, profession, comorbidities, tumor size, lymph node metastasis, distant metastasis, history of breast disease, and family history of breast cancer, were analyzed, as was survival information. RESULTS A total of 1,431 women diagnosed with breast cancers between 1998 and 2005 in Qilu Hospital were enrolled and studied. Delays in diagnosis and treatment were correlated with larger tumor size, lymph node metastasis, late tumor stage, and worse disease-free survival, as assessed by multivariate logistic regression and Kaplan-Meier regression models. Patient residential status, initial symptom, menopausal status, and history of breast disease were independent predictors of delay. Stratified multivariate analyses confirmed that age was not associated with delay. CONCLUSIONS Delay in diagnosis and treatment predicts worse clinical outcomes. Improvement of medical service in rural areas, especially for premenopausal women, can decrease delays and benefit breast cancer patients.
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Affiliation(s)
- Qiang Huo
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China,
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Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol 2014; 5:465-477. [PMID: 25114860 PMCID: PMC4127616 DOI: 10.5306/wjco.v5.i3.465] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/23/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages I and II, only 20%-50% patients in the majority of low- and middle-income countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existent in these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.
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Kannan VD, Veazie PJ. Who avoids going to the doctor and why? Audience segmentation analysis for application of message development. HEALTH COMMUNICATION 2014; 30:635-645. [PMID: 25062466 DOI: 10.1080/10410236.2013.878967] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This exploratory study examines the prevalent and detrimental health care phenomenon of patient delay in order to inform formative research leading to the design of communication strategies. Delayed medical care diminishes optimal treatment choices, negatively impacts prognosis, and increases medical costs. Various communication strategies have been employed to combat patient delay, with limited success. This study fills a gap in research informing those interventions by focusing on the portion of patient delay occurring after symptoms have been assessed as a sign of illness and the need for medical care has been determined. We used CHAID segmentation analysis to produce homogeneous segments from the sample according to the propensity to avoid medical care. CHAID is a criterion-based predictive cluster analysis technique. CHAID examines a variety of characteristics to find the one most strongly associated with avoiding doctor visits through a chi-squared test and assessment of statistical significance. The characteristics identified then define the segments. Fourteen segments were produced. Age was the first delineating characteristic, with younger age groups comprising a greater proportion of avoiders. Other segments containing a comparatively larger percent of avoiders were characterized by lower income, lower education, being uninsured, and being male. Each segment was assessed for psychographic properties associated with avoiding care, reasons for avoiding care, and trust in health information sources. While the segments display distinct profiles, having had positive provider experiences, having high health self-efficacy, and having an internal rather than external or chance locus of control were associated with low avoidance among several segments. Several segments were either more or less likely to cite time or money as the reason for avoiding care. And several older aged segments were less likely than the remaining sample to trust the government as a source for health information. Implications for future research are discussed.
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