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Yoshida S, Hirai K, Ohtake F, Masukawa K, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Preferences of bereaved family members on communication with physicians when discontinuing anticancer treatment: referring to the concept of nudges. Jpn J Clin Oncol 2024; 54:787-796. [PMID: 38553776 PMCID: PMC11228860 DOI: 10.1093/jjco/hyae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/11/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND This study aimed to clarify the situation and evaluate the communication on anticancer treatment discontinuation from the viewpoint of a bereaved family, in reference to the concept of nudges. METHODS A multi-center questionnaire survey was conducted involving 350 bereaved families of patients with cancer admitted to palliative care units in Japan. RESULTS The following explanations were rated as essential or very useful: (i) treatment would be a physical burden to the patient (42.9%), (ii) providing anticancer treatment was impossible (40.5%), (iii) specific disadvantages of receiving treatment (40.5%), (iv) not receiving treatment would be better for the patient (39.9%) and (v) specific advantages of not receiving treatment (39.6%). The factors associated with a high need for improvement of the physician's explanation included lack of explanation on specific advantages of not receiving treatment (β = 0.228, P = 0.001), and lack of explanation of 'If the patient's condition improves, you may consider receiving the treatment again at that time.' (β = 0.189, P = 0.008). CONCLUSIONS Explaining the disadvantages of receiving treatment and the advantages of not receiving treatment, and presenting treatment discontinuation as the default option were effective in helping patients' families in making the decision to discontinue treatment. In particular, explanation regarding specific advantages of not receiving treatment was considered useful, as they caused a lower need for improvement of the physicians' explanation.
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Affiliation(s)
- Saran Yoshida
- Graduate School of Education, Tohoku University, Sendai, Miyagi, Japan
| | - Kei Hirai
- Graduate School of Human Science, Osaka University, Suita, Osaka, Japan
| | - Fumio Ohtake
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Osaka, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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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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3
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Mohd Mujar NM, Dahlui M, Emran NA, Hadi IA, Yan YW, Arulanantham S, Chea CH, Mohd Taib NA. Breast Cancer Care Timeliness Framework: A Quality Framework for Cancer Control. JCO Glob Oncol 2022; 8:e2100250. [PMID: 35286134 PMCID: PMC8932493 DOI: 10.1200/go.21.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study is to determine the pathway that women follow for Breast Cancer Care (BCC) and the time intervals from symptom discovery to treatment initiation and to develop a quality matrix framework. METHODS A retrospective cohort study was conducted at six tertiary centers in Malaysia. All women with newly diagnosed breast cancer were interviewed, and a medical records review was conducted using a structured questionnaire. The BCC timeliness framework showed that the total time between a woman discovering their first breast changes and the date of initial treatment was divided into three distinct intervals: presentation interval, diagnostic interval, and treatment interval. Four diagnosis subintervals, referral, biopsy, report, and diagnosis resolution intervals, were also looked into. RESULTS The BCC timeliness framework was used to capture important time points. The median total time, presentation interval, diagnostic interval, and treatment interval were 4.9 months (range, 1 month to 10 years), 2.4 months (range, 7 days to 10 years), 26 days (range, 4 days to 9.3 months), and 21 days (range, 1 day to 7.2 months), respectively. Meanwhile, the median time for the diagnosis subinterval of referral, biopsy, report, and diagnosis resolution was 8 days (range, 0 day to 8 months), 0 day (range, 0 day to 20 days), 7 days (range, 3 days to 3.5 months), and 4 days (range, 1 day to 1.8 months), respectively. CONCLUSION The BCC timeliness framework is based on the current sequenced trajectory of the BCC journey. Clarity in the measurement of timeliness provides a standardized language for monitoring and outcome research. It can serve as a quality indicator for community and hospital-based breast cancer programs.
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Affiliation(s)
- Noor Mastura Mohd Mujar
- Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | | | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, UM Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Malaysia
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Perceived Barriers to Early Detection of Breast Cancer in Iranian Women: A Qualitative Content Analysis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.101467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Breast cancer is one of the most common cancers among Iranian women. The early diagnosis of this disease can decrease the mortality rate and promote patient survival. Objectives: This study aimed at identifying the barriers to early detection of breast cancer in Iranian women. Methods: In this qualitative study, which was extracted from a large research project, an exploratory sequential mixed-methods design was used, and conventional content analysis was carried out. Twenty-one participants were selected by purposeful sampling (ten health professionals and 11 female patients with breast cancer). Data were collected through in-depth, semi-structured interviews from July 2018 to June 2019. Results: The content analysis revealed three major themes related to delay in presentation: individual barriers (limited/lack of knowledge, other life preferences, negative reactions to the disease, and belief in fate), environmental barriers (insufficient social support, inaccurate information sources, and alternative therapy recommendations), and organizational barriers (poor quality of health services, inadequate access to health services, and role of media in informing people). Conclusions: Various perceived barriers, at different levels, play influential roles in the patients’ early detection. Therefore, collaboration between public health professionals, healthcare providers, and policymakers seems necessary for reducing delays in presentation among women.
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Minué-Lorenzo S, Fernández-Aguilar C, Martín-Martín JJ, Fernández-Ajuria A. [Effect of the use of heuristics on diagnostic error in Primary Care: Scoping review]. Aten Primaria 2020; 52:159-175. [PMID: 30711287 PMCID: PMC7063144 DOI: 10.1016/j.aprim.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/12/2018] [Accepted: 11/03/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the use of representativeness, availability, overconfidence, anchoring and adjustment heuristics in clinical practice, specifically in Primary Care setting. DESIGN Panoramic review (scope review). DATA SOURCES OvidMedline, Scopus, PsycoINFO, Cochrane Library and PubMed databases. Each one of the selected studies was reviewed applying TIDIER criteria (Template for Description of the Intervention and Replication) to facilitate their understanding and replicability. SELECTION OF STUDIES A total of 48 studies were selected that analyzed availability heuristics (26), anchoring and adjustment (9), overconfidence (9) and representativeness (8). RESULTS From the 48 studies selected, 26 analyzed availability heuristics, 9 anchoring and adjustment, 9 overconfidence; and 8 representativeness. The study population included physicians (35.4%), patients (27%), trainees (20.8%), nurses (14.5%) and students (14.5%). The studies conducted in clinical practice setting were 17 (35.4%). In 33 of the 48 studies (68,7%) it was observed heuristic use in the population studied. Heuristics use on diagnostic process was found in 27 studies (54.1%); 5 of them (18%) were carried out in clinical practice setting. Of the 48 studies, 6 (12,5%) were performed in Primary Care, 3 of which studied diagnostic process: only one of them analyzed the use of heuristics in clinical practice setting, without demonstrating bias as consequence of the use of heuristic. CONCLUSION The evidence about heuristic use in diagnostic process on clinical practice setting is limited, especially in Primary Care.
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Affiliation(s)
- Sergio Minué-Lorenzo
- Integrated Health Services based on Primary Health Care WHO Collaborating Centre. Escuela Andaluza de Salud Pública, Granada, España.
| | - Carmen Fernández-Aguilar
- Integrated Health Services based on Primary Health Care WHO Collaborating Centre. Escuela Andaluza de Salud Pública, Granada, España
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Exploring determinants of, and interventions for, delayed presentation of women with breast symptoms: A systematic review. Eur J Oncol Nurs 2020; 44:101677. [DOI: 10.1016/j.ejon.2019.101677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/08/2019] [Accepted: 10/12/2019] [Indexed: 12/24/2022]
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Cook C, Brunton M, Pukepuke T, Tan AL. Exploring communication during the journey from noticing bodily changes to a diagnosis of endometrial cancer. J Clin Nurs 2017; 27:1262-1275. [DOI: 10.1111/jocn.14173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Catherine Cook
- School of Nursing; Massey University; Albany New Zealand
| | - Margaret Brunton
- School of Communication Journalism & Marketing; Massey University; Auckland New Zealand
| | | | - Ai Ling Tan
- Department of Gynaecology Oncology; Auckland City Hospital; Auckland New Zealand
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Making Sense of Turmoil: How Women Reconcile Their Emotional Response to Discovery of a Potential Breast Cancer Symptom. Cancer Nurs 2017; 41:513-519. [PMID: 29116944 DOI: 10.1097/ncc.0000000000000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer continues to be a major public health problem for women. Early detection and treatment are key to improved outcomes. Whereas most women seek help promptly, some postpone seeking help for self-discovered breast symptoms. Investigation of women's help-seeking behavior and the associated influencing factors on self-discovery of a breast symptom were sought. OBJECTIVES The aim of this article is to report the qualitative data from women who had self-discovered a breast symptom. METHODS Women (n = 167) with a self-discovered breast symptom (who were part of a large quantitative correlational study) commented in an open-ended question on their overall experience. Comments were analyzed using Discourse Analysis. RESULTS Four linked discourses were identified: (1) "being and remaining normal," (2) "emotion," (3) "becoming and being abnormal," and (4) "rationality." A sidelined discourse of emotion is drawn on to defer taking action based on rational knowledge. CONCLUSION The tension between discourses "emotion" and "rationality" further informs our understanding of women's help-seeking behavior following self-discovered symptoms. Findings provide a deeper understanding of the emotional aspects of women's experience around symptom discovery. IMPLICATIONS FOR PRACTICE Findings will be of benefit to all healthcare professionals involved in assessment and screening of breast changes suggestive of breast cancer. They provide a novel insight into the meaning of breast cancer, its diagnosis and treatment, and how this impacts women's emotions as they await consultation in a breast clinic.
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Knowledge of cancer symptoms and anxiety affect patient delay in seeking diagnosis in patients with heterogeneous cancer locations. Curr Probl Cancer 2017; 41:64-70. [DOI: 10.1016/j.currproblcancer.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/19/2016] [Indexed: 01/13/2023]
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10
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van Graan AC, Williams MJ, Koen MP. Clinical judgement within the South African clinical nursing environment: A concept analysis. Health SA 2016. [DOI: 10.1016/j.hsag.2015.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jensen LF, Hvidberg L, Pedersen AF, Aro AR, Vedsted P. Time from first symptom experience to help seeking for colorectal cancer patients: Associations with cognitive and emotional symptom representations. PATIENT EDUCATION AND COUNSELING 2016; 99:807-813. [PMID: 27529089 DOI: 10.1016/j.pec.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim was to assess the association between cognitive and emotional symptom representations prior to diagnosis and the length of the patient interval (i.e. the time from the first symptom is experienced until healthcare is sought) for colorectal cancer patients. METHOD The study population included 436 newly diagnosed colorectal cancer patients. Questionnaire data were collected using the Danish Revised Illness Perception Questionnaire (IPQ-R), including cognitive and emotional symptom representations and information on the patient interval. RESULTS High score in treatment control was associated with short patient interval (PR = 0.52, 95% CI: 0.31-0.89) and high score on the timeline cyclical dimension was associated with long patient interval (PR = 2.14, 95% CI: 1.29-3.57). Hence, patients with negative beliefs about the treatability of their symptoms and patients with strong beliefs about the cyclical nature of their symptoms were more likely to have a long patient interval. Assigning blood in stool as the most important symptom significantly interacted in the association between the patient interval and the two cognitive symptom representations consequence and personal control. CONCLUSION The results indicate that aspects of symptom representations were associated with the patient's help-seeking. PRACTICAL IMPLICATIONS These findings may help clinicians and public health planners shorten patient intervals.
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12
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Renzi C, Whitaker KL, Winstanley K, Cromme S, Wardle J. Unintended consequences of an 'all-clear' diagnosis for potential cancer symptoms: a nested qualitative interview study with primary care patients. Br J Gen Pract 2016; 66:e158-70. [PMID: 26852794 PMCID: PMC4758495 DOI: 10.3399/bjgp16x683845] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/30/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nine out of 10 patients undergoing urgent cancer investigations receive an 'all-clear' diagnosis. AIM A qualitative approach was used to evaluate the impact of investigations that did not result in cancer diagnosis on subsequent symptom attribution and help seeking for recurrent or new possible cancer symptoms. DESIGN AND SETTING A survey of symptoms, help seeking, and past investigations was sent to 4913 individuals aged ≥50 years from four UK general practices. Of 2042 responders, 62 participants were recruited still reporting at least one cancer 'alarm' symptom in a 3-month follow-up survey for a nested in-depth interview study (ensuring variation in sociodemographic characteristics). METHOD Framework analysis was used to examine the in-depth semi-structured interviews and identify themes related to previous health investigations. RESULTS Interviewees were on average 65 years old, and 90% reported investigations within the previous 2 years. Most often they reported gastrointestinal, urinary, and respiratory symptoms, and 42% had waited ≥3 months before help seeking. Reassurance from a previous non-cancer diagnosis explained delays in help seeking even if symptoms persisted or new symptoms developed months or years later. Others were worried about appearing hypochondriacal or that they would not be taken seriously if they returned to the doctor. CONCLUSION An all-clear diagnosis can influence help seeking for months or even years in case of new or recurrent alarm symptoms. Considering the increasing number of people undergoing investigations and receiving an all-clear, it is paramount to limit unintended consequences by providing appropriate information and support. Specific issues are identified that could be addressed.
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Affiliation(s)
- Cristina Renzi
- Health Behaviour Research Centre, University College London, London
| | | | - Kelly Winstanley
- Health Behaviour Research Centre, University College London, London
| | - Susanne Cromme
- Health Behaviour Research Centre, University College London, London
| | - Jane Wardle
- Health Behaviour Research Centre, University College London, London
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McCutchan GM, Wood F, Edwards A, Richards R, Brain KE. Influences of cancer symptom knowledge, beliefs and barriers on cancer symptom presentation in relation to socioeconomic deprivation: a systematic review. BMC Cancer 2015; 15:1000. [PMID: 26698112 PMCID: PMC4688960 DOI: 10.1186/s12885-015-1972-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 12/03/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND People from lower socioeconomic groups have worse survival outcomes for cancer, which in part reflects later-stage disease at diagnosis. The mechanisms underlying delayed cancer symptom presentation in lower socioeconomic groups are not well understood. METHODS Systematic review of studies of actual or anticipated symptom presentation across all tumour sites. Included studies measured socioeconomic group, symptom presentation and one or more of the following variables: cancer symptom knowledge, beliefs about cancer, barriers/facilitators to symptom presentation. RESULTS A total of 60 studies was included. Symptom knowledge overall was lowest and actual presentation time was longest in lower socioeconomic groups. Knowledge for specific symptoms such as lumps and bleeding was good and encouraged timely symptom presentation, in contrast to non-specific symptoms which were not well recognised. The combination of fearful and fatalistic beliefs was typically associated with later presentation, especially in lower socioeconomic groups. Emotional barriers such as 'worry what the doctor might find' were more frequently reported in lower socioeconomic groups, and there was evidence to suggest that disclosing symptoms to family/friends could help or hinder early presentation. CONCLUSIONS Poor symptom knowledge, fearful and fatalistic beliefs about cancer, and emotional barriers combine to prolong symptom presentation among lower socioeconomic groups. Targeted interventions should utilise social networks to improve knowledge of non-specific symptoms, challenge negative beliefs and encourage help-seeking, in order to reduce avoidable delays and minimise socioeconomic group inequalities.
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Affiliation(s)
- Grace M McCutchan
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Fiona Wood
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Adrian Edwards
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Rebecca Richards
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Kate E Brain
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
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Whitaker KL, Winstanley K, Macleod U, Scott SE, Wardle J. Low cancer suspicion following experience of a cancer 'warning sign'. Eur J Cancer 2015; 51:2473-9. [PMID: 26264167 PMCID: PMC4622962 DOI: 10.1016/j.ejca.2015.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/03/2015] [Accepted: 07/11/2015] [Indexed: 01/03/2023]
Abstract
Aim Lower socioeconomic status (SES) is associated with a higher risk of late-stage cancer diagnosis. A number of explanations have been advanced for this, but one which has attracted recent attention is lower patient knowledge of cancer warning signs, leading to delay in help-seeking. However, although there is psychometric evidence of SES differences in knowledge of cancer symptoms, no studies have examined differences in ‘cancer suspicion’ among people who are actually experiencing a classic warning sign. Methods A ‘health survey’ was mailed to 9771 adults (⩾50 years, no cancer diagnosis) with a symptom list including 10 cancer ‘warning signs’. Respondents were asked if they had experienced any of the symptoms in the past 3 months, and if so, were asked ‘what do you think caused it?’ Any mention of cancer was scored as ‘cancer suspicion’. SES was indexed by education. Results Nearly half the respondents (1732/3756) had experienced a ‘warning sign’, but only 63/1732 (3.6%) mentioned cancer as a possible cause. Lower education was associated with lower likelihood of cancer suspicion: 2.6% of respondents with school-only education versus 7.3% with university education suspected cancer as a possible cause. In multivariable analysis, low education was the only demographic variable independently associated with lower cancer suspicion (odds ratio (OR) = 0.34, confidence interval (CI): 0.20–0.59). Conclusion Levels of cancer suspicion were low overall in this community sample, and even lower in people from less educated backgrounds. This may hinder early symptomatic presentation and contribute to inequalities in stage at diagnosis.
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Affiliation(s)
- Katriina L Whitaker
- School of Health Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK.
| | - Kelly Winstanley
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.
| | - Una Macleod
- Centre for Health and Population Sciences, Hull York Medical School, Hull HU6 7RX, UK.
| | - Suzanne E Scott
- Unit of Social and Behavioural Sciences, King's College London Dental Institute, London SE5 9RW, UK.
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.
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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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Whitaker KL, Scott SE, Wardle J. Applying symptom appraisal models to understand sociodemographic differences in responses to possible cancer symptoms: a research agenda. Br J Cancer 2015; 112 Suppl 1:S27-34. [PMID: 25734385 PMCID: PMC4385973 DOI: 10.1038/bjc.2015.39] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sociodemographic inequalities in the stage of diagnosis and cancer survival may be partly due to differences in the appraisal interval (time from noticing a bodily change to perceiving a reason to discuss symptoms with a health-care professional). A number of symptom appraisal models have been developed describing the psychological factors that underlie how people make sense of symptoms, although none explicitly focus on sociodemographic characteristics. METHODS We therefore conducted a conceptual review synthesising all symptom appraisal models, and focus on potential links with sociodemographics that could be the focus of future research. RESULTS Common psychological elements across nine symptom appraisal models included knowledge, attention, expectation and identity, all of which could be sensitive to sociodemographic factors. For example, lower socioeconomic status (SES), male sex and older age are associated with lower health literacy generally and lower cancer symptom knowledge. Limited attentional resources, lower expectations about health and lack of social support also hamper symptom interpretation, and would be likely to be more prevalent in those from lower SES backgrounds. Symptom heuristics ('rules of thumb') may lead to symptoms being normalised because they are common within the social network, potentially disadvantaging older populations. CONCLUSIONS A better understanding of the processes through which people interpret their symptoms, and the way these processes differ by sociodemographic factors, could help guide the development of interventions with the aim of reducing inequalities in cancer outcomes.
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Affiliation(s)
- K L Whitaker
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - S E Scott
- Unit of Social and Behavioural Sciences, King's College London Dental Institute, London SE5 9RW, UK
| | - J Wardle
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London WC1E 6BT, UK
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Renzi C, Whitaker KL, Wardle J. Over-reassurance and undersupport after a 'false alarm': a systematic review of the impact on subsequent cancer symptom attribution and help seeking. BMJ Open 2015; 5:e007002. [PMID: 25652803 PMCID: PMC4322204 DOI: 10.1136/bmjopen-2014-007002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES This literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom attribution and delays in help seeking for subsequent possible cancer symptoms. DESIGN AND SETTING The comprehensive literature review included original research based on quantitative, qualitative and mixed data collection methods. We used a combination of search strategies, including in-depth searches of electronic databases (PubMed, EMBASE, PsychInfo), searching key authors and articles listed as 'related' in PubMed, and reference lists. We performed a narrative synthesis of key themes shared across studies. PARTICIPANTS The review included studies published after 1990 and before February 2014 reporting information on adult patients having experienced a false alarm following symptomatic presentation. We excluded false alarms in the context of screening. PRIMARY AND SECONDARY OUTCOME MEASURES We evaluated the effect of a 'false alarm' on symptom attribution and help seeking for new or recurrent possible cancer symptoms. RESULTS Overall, 1442 papers were screened and 121 retrieved for full-text evaluation. Among them, 19 reported on false alarms and subsequent symptom attribution or help seeking. They used qualitative (n=14), quantitative (n=3) and mixed methods (n=2). Breast (n=7), gynaecological (n=3), colorectal (n=2), testicular (n=2), and head and neck cancers (n=2) were the most studied. Two broad themes emerged underlying delays in help seeking: (1) over-reassurance from the previous 'all-clear' diagnosis leading to subsequent symptoms being interpreted as benign, and (2) unsupportive healthcare experiences in which symptoms were dismissed, leaving patients concerned about appearing hypochondriacal or uncertain about the appropriate next actions. The evidence suggested that the effect of a false alarm can persist for months and even years. CONCLUSIONS In conclusion, over-reassurance and undersupport of patients after a false alarm can undermine help seeking in the case of new or recurrent potential cancer symptoms, highlighting the need for appropriate patient information when investigations rule out cancer.
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Affiliation(s)
- Cristina Renzi
- Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK
| | - Katriina L Whitaker
- Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK
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Barriers to healthcare seeking, beliefs about cancer and the role of socio-economic position. A Danish population-based study. Prev Med 2015; 71:107-13. [PMID: 25524610 DOI: 10.1016/j.ypmed.2014.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/30/2014] [Accepted: 12/08/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cancer-related health behaviours may be affected by barriers to healthcare seeking and beliefs about cancer. The aim was to assess anticipated barriers to healthcare seeking and beliefs about cancer in a sample of the Danish population and to assess the association with socio-economic position. METHODS A population-based telephone interview with 3000 randomly sampled persons aged 30 years or older was performed using the Awareness and Beliefs about Cancer measure from 31 May to 4 July 2011. The Awareness and Beliefs about Cancer measure includes statements about four anticipated barriers to healthcare seeking and three positively and three negatively framed beliefs about cancer. For all persons, register-based information on socio-economic position was obtained through Statistics Denmark. RESULTS Two anticipated barriers, worry about what the doctor might find and worry about wasting the doctor's time, were present among 27% and 15% of the respondents, respectively. Overall, a high proportion of respondents concurred with positive beliefs about cancer; fewer concurred with negative beliefs. Having a low educational level and a low household income were strongly associated with having negative beliefs about cancer. CONCLUSION The fact that worry about what the doctor might find and worry about wasting the doctor's time were commonly reported barriers call for initiatives in general practice. The association between low educational level and low household income and negative beliefs about cancer might to some degree explain the negative socio-economic gradient in cancer outcome.
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Blumenthal-Barby JS, Krieger H. Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Med Decis Making 2014; 35:539-57. [PMID: 25145577 DOI: 10.1177/0272989x14547740] [Citation(s) in RCA: 288] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 07/26/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The role of cognitive biases and heuristics in medical decision making is of growing interest. The purpose of this study was to determine whether studies on cognitive biases and heuristics in medical decision making are based on actual or hypothetical decisions and are conducted with populations that are representative of those who typically make the medical decision; to categorize the types of cognitive biases and heuristics found and whether they are found in patients or in medical personnel; and to critically review the studies based on standard methodological quality criteria. METHOD Data sources were original, peer-reviewed, empirical studies on cognitive biases and heuristics in medical decision making found in Ovid Medline, PsycINFO, and the CINAHL databases published in 1980-2013. Predefined exclusion criteria were used to identify 213 studies. During data extraction, information was collected on type of bias or heuristic studied, respondent population, decision type, study type (actual or hypothetical), study method, and study conclusion. RESULTS Of the 213 studies analyzed, 164 (77%) were based on hypothetical vignettes, and 175 (82%) were conducted with representative populations. Nineteen types of cognitive biases and heuristics were found. Only 34% of studies (n = 73) investigated medical personnel, and 68% (n = 145) confirmed the presence of a bias or heuristic. Each methodological quality criterion was satisfied by more than 50% of the studies, except for sample size and validated instruments/questions. Limitations are that existing terms were used to inform search terms, and study inclusion criteria focused strictly on decision making. CONCLUSIONS Most of the studies on biases and heuristics in medical decision making are based on hypothetical vignettes, raising concerns about applicability of these findings to actual decision making. Biases and heuristics have been underinvestigated in medical personnel compared with patients.
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Affiliation(s)
- J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX (JSBB)
| | - Heather Krieger
- Department of Social Psychology, University of Houston, Houston, TX (HK)
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Breast cancer patients' experiences within and outside the safety net. J Surg Res 2014; 190:126-33. [PMID: 24768022 DOI: 10.1016/j.jss.2014.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/03/2014] [Accepted: 03/12/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Following reforms to the breast-cancer referral process for our city's health Safety Net (SN), we compared the experiences from first abnormality to definitive diagnosis of breast-cancer patients referred to Siteman Cancer Center from SN and non-SN (NSN) providers. MATERIALS AND METHODS SN-referred patients with any stage (0-IV) and NSN-referred patients with late-stage (IIB-IV) breast cancer were prospectively identified after diagnosis during cancer center consultations conducted between September 2008 and June 2010. Interviews were taped and transcribed verbatim; transcripts were independently coded by two raters using inductive methods to identify themes. RESULTS Of 82 eligible patients, 57 completed interviews (33/47 SN [70%] and 24/35 NSN [69%]). Eighteen SN-referred patients (52%) had late-stage disease at diagnosis, as did all NSN patients (by design). A higher proportion of late-stage SN patients (67%) than either early-stage SN (47%) or NSN (33%) patients reported feelings of fear and avoidance that deterred them from pursuing care for concerning breast findings. A higher proportion of SN late-stage patients than NSN patient reported behaviors concerning for poor health knowledge or behavior (33% versus 8%), but reported receipt of timely, consistent communication from health care providers once they received care (50% versus 17%). Half of late-stage SN patients reported improper clinical or administrative conduct by health care workers that delayed referral and/or diagnosis. CONCLUSIONS Although SN patients reported receipt of compassionate care once connected with health services, they presented with higher-than-expected rates of late-stage disease. Psychological barriers, life stressors, and provider or clinic delays affected access to and navigation of the health care system and represent opportunities for intervention.
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Andersen RS, Risør MB. The importance of contextualization. Anthropological reflections on descriptive analysis, its limitations and implications. Anthropol Med 2014; 21:345-356. [PMID: 24484056 DOI: 10.1080/13648470.2013.876355] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper regards a concern for the quality of analyses made on the basis of qualitative interviews in some parts of qualitative health research. Starting with discussions departing in discussions on studies exploring 'patient delay' in healthcare seeking, it is argued that an implicit and simplified notion of causality impedes reflexivity on social context, on the nature of verbal statements and on the situatedness of the interview encounter. Further, the authors suggest that in order to improve the quality of descriptive analyses, it is pertinent to discuss the relationship between notions of causality and the need for contextualization in particular. This argument targets several disciplines taking a qualitative approach, including medical anthropology. In particular, researchers working in interdisciplinary fields face the demands of producing knowledge ready to implement, and such demands challenge basic notions of causality and explanatory power. In order to meet these, the authors suggest an analytic focus on process causality linked to contextualization.
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Affiliation(s)
- Rikke Sand Andersen
- a Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health & Department of Society and Culture - Anthropology, Faculty of Arts , Aarhus University , Aarhus , 8000 Denmark
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Hvidberg L, Jensen LF, Pedersen AF, Aro AR, Vedsted P. Measurement properties of the Danish version of the Illness Perception Questionnaire-Revised for patients with colorectal cancer symptoms. J Health Psychol 2013; 19:1279-90. [PMID: 23818508 DOI: 10.1177/1359105313488978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to validate the measurement properties of the Danish version of the Illness Perception Questionnaire-Revised adapted to measure symptom representations among patients with colorectal cancer symptoms. A total of 488 colorectal cancer patients completed a questionnaire derived from the Illness Perception Questionnaire-Revised to retrospectively assess cognitive and emotional representations of experienced symptoms. A confirmatory factor analysis indicated no good comparative fit with the Illness Perception Questionnaire-Revised. Using exploratory factor analysis, a 7-factor structure was conducted, which fairly supported the Illness Perception Questionnaire-Revised. The modified Illness Perception Questionnaire-Revised is a promising tool for measuring symptom representations among Danish colorectal cancer patients.
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Affiliation(s)
- Line Hvidberg
- The Research Centre for Cancer Diagnosis in Primary Care (CaP), The Research Unit for General Practice, Aarhus University, Denmark
| | - Line F Jensen
- The Research Centre for Cancer Diagnosis in Primary Care (CaP), The Research Unit for General Practice, Aarhus University, Denmark
| | - Anette F Pedersen
- The Research Centre for Cancer Diagnosis in Primary Care (CaP), The Research Unit for General Practice, Aarhus University, Denmark
| | - Arja R Aro
- Unit for Health Promotion Research, University of Southern Denmark, Denmark
| | - Peter Vedsted
- The Research Centre for Cancer Diagnosis in Primary Care (CaP), The Research Unit for General Practice, Aarhus University, Denmark
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Angus JE, Lombardo AP, Lowndes RH, Cechetto N, Ahmad F, Bierman AS. Beyond barriers in studying disparities in women's access to health services in Ontario, Canada: a qualitative metasynthesis. QUALITATIVE HEALTH RESEARCH 2013; 23:476-94. [PMID: 23427078 DOI: 10.1177/1049732312469464] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Women live within complex and differing social, economic, and environmental circumstances that influence options to seek health care. In this article we report on a metasynthesis of qualitative research concerning access disparities for women in the Canadian province of Ontario, where there is a publicly funded health care system. We took a metastudy approach to analysis of results from 35 relevant qualitative articles to understand the conditions and conceptualizations of women's inequitable access to health care. The articles' authors attributed access disparities to myriad barriers. We focused our analysis on these barriers to understand the contributing social and political forces. We found that four major, sometimes countervailing, forces shaped access to health care: (a) contextual conditions, (b) constraints, (c) barriers, and (d) deterrents. Complex convergences of these forces acted to push, pull, obstruct, and/or repel women as they sought health care, resulting in different patterns of inequitable access.
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Affiliation(s)
- Jan E Angus
- University of Toronto, Toronto, Ontario, Canada.
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Fayanju OM, Jeffe DB, Elmore L, Ksiazek DN, Margenthaler JA. Patient and process factors associated with late-stage breast cancer diagnosis in Safety-Net patients: a pilot prospective study. Ann Surg Oncol 2012; 20:723-32. [PMID: 23070783 DOI: 10.1245/s10434-012-2558-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Following reforms to our city's Safety-Net (SN) breast cancer referral process, we investigated whether factors often associated with late-stage diagnosis would differ by referral source--SN versus non-Safety-Net (NSN)--or, among SN patients, by stage at diagnosis. METHODS From September 2008 to June 2010, SN patients with any-stage (0-IV) and NSN patients with late-stage (IIB-IV) breast cancer were identified prospectively during initial cancer-center consultations. Data were analyzed using logistic regression, chi-square, and t tests; two-tailed P < 0.05 was considered significant. RESULTS Fifty-seven women completed interviews (33 SN, 24 NSN); 52% of SN-referred patients were diagnosed with late-stage disease. Compared with NSN late-stage patients, SN late-stage patients were more likely to be African-American (83% vs. 21%, P < 0.001), to have an annual household income <$25,000 (89% vs. 38%, P < 0.001), and to report having a health problem in the preceding year but not being able to see a doctor because of cost (67% vs. 25%, P = 0.012); they were less likely to be married/partnered (22% vs. 79%, P < 0.001) and to have post-college education (0% vs. 25%, P < 0.03), any insurance (61% vs. 96%, P < 0.005), and to have sought medical attention within 1 week of realizing they had concerning breast findings (50% vs. 79%, P = 0.047). Married/partnered patients were more likely to delay medical care by >1 week (odds ratio = 9.9, P = 0.038). CONCLUSIONS SN patients presented with higher-than-expected rates of late-stage disease despite improvements in mammography rates and the referral process. Efforts to further facilitate access to care for this vulnerable SN patient population are needed.
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Granek L, Fergus K. Resistance, agency, and liminality in women's accounts of symptom appraisal and help-seeking upon discovery of a breast irregularity. Soc Sci Med 2012; 75:1753-61. [PMID: 22884943 DOI: 10.1016/j.socscimed.2012.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 07/04/2012] [Accepted: 07/12/2012] [Indexed: 11/19/2022]
Abstract
In the breast cancer literature, "delayed presentation" is defined as a period of 3 months or more between the self-detection of a new breast symptom and the decision to seek help for it. Delay studies have overlooked the relevance of dominant medical discourses such as those concerning "proper" health. In this paper we use a critical discursive method to analyze interviews with 14 women about their symptom appraisal process to demonstrate how many inhabited a liminal space comprised of both "knowing and not knowing" about the symptom, and "acting and not acting" on it (interviews took place from January 2006 to April 2007). We describe three discursive themes that arose in the transcripts including "Doing the right thing", "Deliberate ignorance", and "Passive resistance." These women's narratives are juxtaposed with two commonly accepted medical discourses in relation to self-detected breast symptoms: That of the woman who was unaware of her symptom, or interpreted it as being insignificant, and therefore, not requiring medical attention; or that of the woman who noticed the symptom, interpreted it as threatening, and immediately sought medical attention. We suggest that such discourses are constricting and fail to account for the sizeable number of women who do not fit this mold (i.e., those who are both aware of the concerning change and delay presentation). We conclude that these constricting medical discourses effectively have a role to play in the contradictory reasoning or perceived irrationality of women's delay behavior when it occurs.
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Affiliation(s)
- Leeat Granek
- Ben Gurion University of the Negev, Department of Sociology of Health, Be'er Sheva 84105, Israel.
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27
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Aboud FE, Singla DR. Challenges to changing health behaviours in developing countries: a critical overview. Soc Sci Med 2012; 75:589-94. [PMID: 22633158 DOI: 10.1016/j.socscimed.2012.04.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 04/25/2012] [Indexed: 11/26/2022]
Abstract
This overview of recent research on health behaviour change in developing countries shows progress as well as pitfalls. In order to provide guidance to health and social scientists seeking to change common practices that contribute to illness and death, there needs to be a common approach to developing interventions and evaluating their outcomes. Strategies forming the basis of interventions and programs to change behaviour need to focus on three sources: theories of behaviour change, evidence for the success and failure of past attempts, and an in-depth understanding of one's audience. Common pitfalls are a lack of attention to the wisdom of theories that address strategies of change at the individual, interpersonal, and community levels. Instead, programs are often developed solely from a logic model, formative qualitative research, or a case-control study of determinants. These are relevant, but limited in scope. Also limited is the focus solely on one's specific behaviour; regardless of whether the practice concerns feeding children or seeking skilled birth attendants or using a latrine, commonalities among behaviours allow generalizability. What we aim for is a set of guidelines for best practices in interventions and programs, as well as a metric to assess whether the program includes these practices. Some fields have approached closer to this goal than others. This special issue of behaviour change interventions in developing countries adds to our understanding of where we are now and what we need to do to realize more gains in the future.
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Scott SE, Walter FM, Webster A, Sutton S, Emery J. The model of pathways to treatment: conceptualization and integration with existing theory. Br J Health Psychol 2012; 18:45-65. [PMID: 22536840 DOI: 10.1111/j.2044-8287.2012.02077.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studying and understanding pathways to diagnosis and treatment is vital for the development of successful interventions to encourage early detection, presentation, and diagnosis. An existing framework posited to describe the decisional and behavioural processes that occur prior to treatment (Andersen et al.'s General Model of Total Patient Delay) does not appear to match the complex and dynamic nature of the pathways into and through the health care system or provide a clear framework for research. Therefore a revised descriptive framework, the Model of Pathways to Treatment, has been proposed. PURPOSE This paper presents the concepts and definitions of the Model of Pathways to Treatment and specifies how the model can encompass existing psychological theory, with particular focus on the Appraisal and Help-seeking intervals. The potential and direction for future work is also discussed. STATEMENT OF CONTRIBUTION WHAT IS ALREADY KNOWN ON THIS SUBJECT?: • The use of theory is often lacking in existing research into delays in presentation, diagnosis and treatment of illness. WHAT DOES THIS STUDY ADD?: • A detailed account of the concepts and definitions of a revised framework: the Model of Pathways to Treatment. • Specification of how the Model of Pathways to Treatment can encompass existing psychological theory such as the Common Sense Model of Illness Self-regulation and Social Cognitive Theory.
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Affiliation(s)
- S E Scott
- Unit of Social & Behavioural Sciences, Dental Institute, King's College London, UK.
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Solbjør M, Skolbekken JA, Sætnan AR, Hagen AI, Forsmo S. Could screening participation bias symptom interpretation? An interview study on women's interpretations of and responses to cancer symptoms between mammography screening rounds. BMJ Open 2012; 2:bmjopen-2012-001508. [PMID: 23148341 PMCID: PMC3532989 DOI: 10.1136/bmjopen-2012-001508] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore how women with negative mammography screening results, but who were later diagnosed with interval breast cancer, reacted when they observed breast symptoms that could indicate malignancy in-between screening rounds. DESIGN Semistructured individual interviews with women who have been diagnosed with breast cancer during mammography screening intervals. SETTING Two breast diagnostic units covering two counties in Norway. PARTICIPANTS 26 women diagnosed with interval breast cancer. RESULTS Women with a screening negative result react in two ways when experiencing a possible symptom of breast cancer. Among 24 women with a self-detected palpable lesion, 14 sought medical advice immediately. Their argument was to dispose of potential cancer as soon as possible. Ten women delayed seeking medical advice, explaining their delay as a result of practical difficulties such as holidays, uncertainty about the symptom, and previous experiences of healthcare services' ability to handle diffuse symptoms. Also, a recent negative mammography scan led some women to assume that the palpable lesion was benign and wait for the next screening round. CONCLUSIONS Participating in mammography screening may contribute to a postponed reaction to breast cancer symptoms, although most women acted rapidly when detecting a palpable breast lesion. Furthermore, screening participation does not necessarily increase awareness of breast cancer symptoms.
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Affiliation(s)
- Marit Solbjør
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medical Faculty, Trondheim, Norway
| | - John-Arne Skolbekken
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ann Rudinow Sætnan
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Irene Hagen
- Department of Breast and Endocrine Surgery, Trondheim University Hospital, Trondheim, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medical Faculty, Trondheim, Norway
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Factors associated with delayed care-seeking in hospitalized patients with heart failure. Heart Lung 2011; 41:244-54. [PMID: 22054724 DOI: 10.1016/j.hrtlng.2011.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 09/09/2011] [Accepted: 09/10/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study sought to evaluate the contributions of symptom recognition and clinical factors to delays in care-seeking. METHODS A descriptive correlational study design was used to study 75 patients (mean age, 74.7 years; SD, 10.86 years; range, 40 to 96 years) admitted to a tertiary-care medical center with recurrent symptoms (New York Heart Association classes 2 to 4). The sample was 52% male and 85.3% white. The Heart Failure Somatic Perception Scale (HFSPS) was used to examine symptoms, and additional data were collected on physiologic, social, and demographic factors. RESULTS The mean HFSPS score was 37.52 (range, 2 to 74; possible range, 0 to 90). Subjects reported 2 to 16 out of 18 possible symptoms. Durations of individual symptoms ranged from 5 minutes to 8 years, with individual patients describing a variety of symptom combinations and multiple time frames, depending on the specific symptom. Most subjects (80%) reported a mixture of acute and chronic symptoms. A pattern of chronic vs. acute symptoms was associated with proactive vs. emergent care-seeking, respectively. The HFSPS scores did not correlate with care-seeking behavior. CONCLUSION Symptom recognition is a complex phenomenon, and few factors differentiate emergent from proactive care-seeking.
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Li WWY, Lam WWT, Wong JHF, Chiu A, Chan M, Or A, Kwong A, Suen D, Chan SWW, Fielding R. Waiting to see the doctor: understanding appraisal and utilization components of consultation delay for new breast symptoms in Chinese women. Psychooncology 2011. [DOI: 10.1002/pon.2038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wylie W. Y. Li
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
| | - Wendy W. T. Lam
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
| | - Jennifer H. F. Wong
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
| | - April Chiu
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
| | - Miranda Chan
- Department of Surgery; Kwong Wah Hospital; Hong Kong
| | - Amy Or
- Department of Surgery; Kwong Wah Hospital; Hong Kong
| | - Ava Kwong
- Department of Surgery; The University of Hong Kong; Hong Kong
| | - Dacita Suen
- Department of Surgery; The University of Hong Kong; Hong Kong
| | | | - Richard Fielding
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
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Power TE, Swartzman LC, Robinson JW. Cognitive-emotional decision making (CEDM): a framework of patient medical decision making. PATIENT EDUCATION AND COUNSELING 2011; 83:163-169. [PMID: 20573468 DOI: 10.1016/j.pec.2010.05.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 04/21/2010] [Accepted: 05/25/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Assistance for patients faced with medical decisions has largely focussed on the clarification of information and personal values. Our aim is to draw on the decision research describing the role of emotion in combination with health behaviour models to provide a framework for conceptualizing patient decisions. METHODS A review of the psychological and medical decision making literature concerned with the role of emotion/affect in decision making and health behaviours. RESULTS Emotion plays an influential role in decision making. Both current and anticipated emotions play a motivational role in choice. Amalgamating these findings with that of Leventhal's (1970) SRM provide a framework for thinking about the influence of emotion on a patient medical decision. CONCLUSION Our framework suggests that a patient must cope with four sets of elements. The first two relate to the need to manage the cognitive and emotional aspects of the health threat. The second set relate to the management of the cognitive and emotional elements of the decision, itself. PRACTICE IMPLICATIONS The framework provides a way for practitioners and researchers to frame thinking about a patient medical decision in order to assist the patient in clarifying decisional priorities.
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Affiliation(s)
- Tara E Power
- Calgary Breast Health Program, Alberta Health Services, Calgary, Canada.
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Breast cancer management in middle-resource countries (MRCs): Consensus statement from the Breast Health Global Initiative. Breast 2011; 20 Suppl 2:S12-9. [DOI: 10.1016/j.breast.2011.02.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 02/11/2011] [Indexed: 11/27/2022] Open
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Breast cancer delay: A grounded model of help-seeking behaviour. Soc Sci Med 2011; 72:1096-104. [DOI: 10.1016/j.socscimed.2011.01.022] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 09/06/2010] [Accepted: 01/20/2011] [Indexed: 02/07/2023]
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Howard AF, Balneaves LG, Bottorff JL, Rodney P. Preserving the self: the process of decision making about hereditary breast cancer and ovarian cancer risk reduction. QUALITATIVE HEALTH RESEARCH 2011; 21:502-19. [PMID: 20980697 PMCID: PMC4880460 DOI: 10.1177/1049732310387798] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Women who carry BRCA1 or BRCA2 (BRCA1/2) gene mutations have up to an 88% lifetime risk of breast cancer and up to a 65% lifetime risk of ovarian cancer. Strategies to address these risks include cancer screening and risk-reducing surgery (i.e., mastectomy and salpingo-oophorectomy). We conducted a grounded theory study with 22 BRCA1/2 mutation-carrier women to understand how women make decisions about these risk-reducing strategies. Preserving the self was the overarching decision-making process evident in the participants' descriptions. This process was shaped by contextual conditions including the characteristics of health services, the nature of hereditary breast and ovarian cancer risk-reduction decisions, gendered roles, and the women's perceived proximity to cancer. The women engaged in five decision-making styles, and these were characterized by the use of specific decision-making approaches. These findings provide theoretical insights that could inform the provision of decisional support to BRCA1/2 carriers.
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Affiliation(s)
- A Fuchsia Howard
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Fergus K, Fitzgerald B, Granek L, Clemons M, Zalany L, Eisen A. The symptom appraisal of breast cancer in the context of an intimate relationship. J Health Psychol 2011; 16:653-66. [DOI: 10.1177/1359105310386634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this qualitative investigation was to understand how a self-detected breast abnormality is experienced within the context of an intimate relationship. Of specific interest were spousal interactions that influenced (facilitated or impeded) timely presentation for medical evaluation. Fourteen women who were in a relationship at the time of symptom discovery and seven of their male partners were interviewed. Interview transcripts were analyzed using the grounded theory method. Tenuous Knowing and Spiral of Disclosure defined two main processes that a woman negotiated within herself in relation to her partner upon discovery of a breast change.
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Affiliation(s)
- Karen Fergus
- York University, Toronto, Canada, , Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | | - Lynn Zalany
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrea Eisen
- Sunnybrook Health Sciences Centre, Toronto, Canada
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Bright K, Barghash M, Donach M, de la Barrera MG, Schneider RJ, Formenti SC. The role of health system factors in delaying final diagnosis and treatment of breast cancer in Mexico City, Mexico. Breast 2011; 20 Suppl 2:S54-9. [PMID: 21371885 DOI: 10.1016/j.breast.2011.02.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In Mexico, breast cancer is the leading cancer-related death among women and most cases are diagnosed at advanced stages (50-60%). We hypothesized health system factors could be partly responsible for this delay and performed a prospective review of 166 new breast cases at a major public hospital in Mexico City. Our analysis confirmed the prevalence of locally advanced and metastatic disease (47% of patients). A subset analysis of 32 women with confirmed stage I-IIIC breast cancer found an average time interval of 1.8 months from symptom onset to first primary care consultation (PCC), with an additional 6.6 months from first PCC to confirmed diagnosis, and 0.6 months from diagnosis to treatment initiation. Patients underwent an average of 7.9 clinic visits before confirmed diagnosis. Findings suggest that protracted referral time from primary to specialty care accounts for the bulk of delay, with earlier stage patients experiencing longer delays. These findings reveal a critical need for further study and exploration of interventions.
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Affiliation(s)
- Kristin Bright
- New York University School of Medicine, New York, NY, USA.
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Scott S, Walter F. Studying Help-Seeking for Symptoms: The Challenges of Methods and Models. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2010. [DOI: 10.1111/j.1751-9004.2010.00287.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Andersen RS, Paarup B, Vedsted P, Bro F, Soendergaard J. 'Containment' as an analytical framework for understanding patient delay: a qualitative study of cancer patients' symptom interpretation processes. Soc Sci Med 2010; 71:378-385. [PMID: 20488607 DOI: 10.1016/j.socscimed.2010.03.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 03/02/2010] [Accepted: 03/25/2010] [Indexed: 11/30/2022]
Abstract
Recent decades have seen much variation in survival and mortality among European cancer patients, with rather small increases in survival, especially among patients in UK and Denmark. This poor outcome has been ascribed tentatively to patient delay since an estimated 20-25% of all cancer patients report having experienced cancer-related symptoms for more than three months before seeking care. In this article we analyse semi-structured interviews with 30 adult Danish cancer patients and their families. Special focus is given to symptom interpretation processes, and how these processes potentially delay care-seeking decisions. The paper adopts a contextual approach inspired mainly by the sociologist Alonzo's (1979, 1984) concept of containment. Alonzo's theory is supplemented with recent anthropological and sociological literature on how people establish the relation between bodily sensations and symptoms and decide how to respond adequately to these. We present an analysis illustrating that bodily sensations and symptoms are potentially contained in a dynamic interplay of factors related to specific social situations, life biographies and life expectations and their accordance with culturally acceptable values and explanations. Finally, we discuss the implications of the analysis for future studies on patient delay.
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Affiliation(s)
- Rikke Sand Andersen
- Research Unit for General Practice, Department of Public Health, University of Aarhus, Bartholins Alle 2, 8000 Århus, Denmark.
| | - Bjarke Paarup
- Department of Anthropology, Archeology and Linguistics, University of Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, University of Aarhus, Bartholins Alle 2, 8000 Århus, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Department of Public Health, University of Aarhus, Bartholins Alle 2, 8000 Århus, Denmark
| | - Jens Soendergaard
- The Research Unit for Family Medicine, Institute of Health Services Research, University of Southern Denmark, Denmark
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Jones SC, Gregory P, Nehill C, Barrie L, Luxford K, Nelson A, Zorbas H, Iverson D. Australian women's awareness of breast cancer symptoms and responses to potential symptoms. Cancer Causes Control 2010; 21:945-58. [PMID: 20177964 DOI: 10.1007/s10552-010-9522-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 02/09/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Poor awareness of breast cancer symptoms has been associated with patient delay in seeking help; thus reduced survival, more aggressive treatment, and fewer treatment choices. The aim of this study was to develop a representative picture of Australian women's knowledge of symptoms, experienced potential symptoms, and behavioral responses. METHODS A general population sample of approximately 3,000 women aged 30-69 completed a telephone survey; results were compared to previous surveys conducted in 1996 and 2003. RESULTS The most commonly cited potential symptom of breast cancer was a lump in the breast, identified by 86% of respondents (an increase from 75% in 2003). Other commonly mentioned symptoms were discharge from the nipple, pain/soreness, skin puckering, or dimpling; and a change in breast shape. The proportion unable to name any potential symptoms of breast cancer decreased from one in ten in 2003 to approximately one in twenty in 2007. The primary reason for not seeking medical advice in response to a potential symptom was the belief that breast cancer was not present. CONCLUSIONS Health promotion efforts need to continue to aim at increasing community understanding of potential breast cancer symptoms and encouraging women to act on potential symptoms by seeking medical advice.
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Affiliation(s)
- Sandra C Jones
- Centre for Health Initiatives, University of Wollongong, Wollongong, NSW, 2522, Australia.
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Umeh K, Jones L. Mutually dependent health beliefs associated with breast self-examination in British female university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2010; 59:126-131. [PMID: 20864439 DOI: 10.1080/07448481.2010.484453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Whereas research suggests young women's beliefs about breast cancer (susceptibility/severity) and its early detection (barriers/benefits) reliably distinguish breast self-examiners from nonexaminers, this study assessed whether these impressions are interreliant, especially in the context of familial risk. PARTICIPANTS The sample comprised over 200 female undergraduates from a university in England, United Kingdom. METHODS Participants completed a self-administered survey on their attitudes concerning breast cancer and early detection. Data were analyzed using logistic regression analysis. RESULTS Nonexaminers were distinguished by a combination of greater perceived hindrances to self-examinations and stronger appraisals of breast cancer severity, and also by a permutation of fewer perceived benefits in self-examinations and lower perceived susceptibility to breast cancer. The latter interaction persisted after accounting for family history. CONCLUSIONS Interwoven attitudes may depict sophisticated efforts on the part of nonexaminers to justify inaction. Clinical implications for college health providers are considered.
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Affiliation(s)
- Kanayo Umeh
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, United Kingdom.
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Andersen RS, Vedsted P, Olesen F, Bro F, Søndergaard J. Patient delay in cancer studies: a discussion of methods and measures. BMC Health Serv Res 2009; 9:189. [PMID: 19840368 PMCID: PMC2770466 DOI: 10.1186/1472-6963-9-189] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 10/19/2009] [Indexed: 11/23/2022] Open
Abstract
Background There is no validated way of measuring the prevalence and duration of patient delay, and we do not know how people perceive and define the time intervals they are asked to report in patient delay studies. This lack of a validated measure hampers research in patient delay and is counterproductive to efforts directed at securing early diagnosis of cancer. Discussion The main argument of the present paper is that current studies on patient delay do not sufficiently consider existing theories on symptom interpretation. It is illustrated that the interpretation of bodily sensations as symptoms related to a specific cancer diagnosis is embedded within a social and cultural context. We therefore cannot assume that respondents define delay periods in identical ways. Summary In order to improve the validity of patient delay studies, it is suggested that research be strengthened on three counts: More research should be devoted to symptom interpretation processes, more research should seek to operationalise patient delay, and, importantly, more research is needed to develop valid instruments for measuring patient delay.
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Affiliation(s)
- Rikke Sand Andersen
- The Research Unit for General Practice, Institute of Public Health, University of Aarhus, Bartholins Allé 2, DK-8000 Aarhus C, Denmark.
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Anderson BO, Jakesz R, El Saghir NS, Yip CH, Khaled HM, Otero IV, Adebamowo CA, Badwe RA, Harford JB. Breast cancer issues in developing countries: an overview of the Breast Health Global Initiative. World J Surg 2009; 12:387-98. [PMID: 18283512 DOI: 10.1016/s1470-2045(11)70031-6] [Citation(s) in RCA: 210] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Of the 411,000 breast cancer deaths around the world in 2002, 221,000 (54%) occurred in low- and middle-income countries (LMCs). Guidelines for breast health care (early detection, diagnosis, and treatment) that were developed in high-resource countries cannot be directly applied in LMCs, because these guidelines do not consider real world resource constraints, nor do they prioritize which resources are most critically needed in specific countries for care to be most effectively provided. METHODS Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for LMCs to improve breast health outcomes. The BHGI held two Global Summits in October 2002 (Seattle) and January 2005 (Bethesda) and using an expert consensus, evidence-based approach developed resource-sensitive guidelines that define comprehensive pathways for step-by-step quality improvement in health care delivery. RESULTS The BHGI guidelines, now published in English and Spanish, stratify resources into four levels (basic, limited, enhanced, and maximal), making the guidelines simultaneously applicable to countries of differing economic capacities. The BHGI guidelines provide a hub for linkage among clinicians and alliance among governmental agencies and advocacy groups to translate guidelines into policy and practice. CONCLUSIONS The breast cancer problem in LMCs can be improved through practical interventions that are realistic and cost-effective. Early breast cancer detection and comprehensive cancer treatment play synergistic roles in facilitating improved breast cancer outcomes. The most fundamental interventions in early detection, diagnosis, surgery, radiation therapy, and drug therapy can be integrated and organized within existing health care schemes in LMCs. Future research will study what implementation strategies can most effectively guide health care system reorganization to assist countries that are motivated to improve breast cancer outcome in their populations.
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Affiliation(s)
- Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Abstract
Breast cancer is a significant threat to Chinese women living in the United States. The purposes of this study are, first, to examine the relationships among breast cancer risk knowledge, general cancer beliefs, and breast examination practices and, second, to determine the predictors of breast examination practices among Chinese women in New York. The study offers a descriptive approach that makes use of a correlation cross-sectional survey (N = 135). Five significant predictors are related to breast examination practices as a result of the study findings: age, acculturation, private insurance status, legal status, and length of stay in New York. Findings show that women who have regular breast examinations most likely belong to older generations, as compared with their younger peers. Study findings suggest that healthcare providers must become more culturally sensitive to the practices and needs of Chinese immigrants. Evidently, providing information regarding cancer prevention targeted for female Chinese immigrants can help increase use of cancer screening tests.
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O'Mahony M, Hegarty J. Factors influencing women in seeking help from a health care professional on self discovery of a breast symptom, in an Irish context. J Clin Nurs 2009; 18:2020-9. [PMID: 19207801 DOI: 10.1111/j.1365-2702.2008.02564.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To identify the extent of delay and the factors influencing women in seeking help from a health care professional on self discovery of a breast symptom, in an Irish context. BACKGROUND Breast cancer is the most common malignancy among women in the developed world. In Ireland, 2700 women are diagnosed with breast cancer and over 900 die from it annually. A longer delay in presenting with breast symptoms is associated with a lower rate of survival from breast cancer. However, many women wait for longer than three months before presenting to a health care professional on self discovery of a breast symptom. DESIGN A quantitative correlational design was used. METHODS Data were collected using the 'Women's help seeking for breast symptoms' questionnaire. Women were recruited in the breast clinic prior to their visit with the consultant. RESULTS A total of 100 women participated, 99 of whom fully completed the questionnaire. Mean age was 40 years. It was found that 72.7% (n = 73) of women visited their GP within one month, 14.1% (n = 14) within one to three months and 10% (n = 12) after three months. Delay time was significantly related to women's knowledge and beliefs and social issues. Conversely, help seeking also correlated to women's knowledge and beliefs about the symptom and the anxiety surrounding the initial symptom discovery period. CONCLUSION Despite breast health promotion campaigns, many women delay for one month or more, in seeking help from a health care professional for self discovered breast symptoms. Prolonged delay has potential to impact on survival from breast cancer. This highlights the need for continued education and breast health promotion for women. RELEVANCE TO CLINICAL PRACTICE Health care professionals need to be aware of possible reasons for delay in seeking help for self discovered breast symptoms and explore new ways to address these barriers.
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Affiliation(s)
- Mairin O'Mahony
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
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Lam WWT, Tsuchiya M, Chan M, Chan SWW, Or A, Fielding R. Help-seeking patterns in Chinese women with symptoms of breast disease: a qualitative study. J Public Health (Oxf) 2008; 31:59-68. [DOI: 10.1093/pubmed/fdn088] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Although symptoms suggestive of cancer are the most common reason that people seek healthcare, the process undertaken to disclose the symptoms is unclear. The purpose of this article is to critically analyze the concept of symptom disclosure in the context of cancer. Rodgers' evolutionary approach was applied to analyze the concept of symptom disclosure. Concept analysis indicates that symptom disclosure is a decision-making process in which a person chooses to tell significant others and a healthcare provider about self-identified symptoms. Characteristics of the concept include symptom interpretation, weighing the risks and benefits of disclosure, and taking action. Influencing factors are knowledge, cancer risk perception, personal or family history of cancer, socioeconomic and cultural factors, and access to care. The concept analysis of symptom disclosure provides guidance for developing strategies to promote healthcare-seeking behavior in practice and suggest areas for future research.
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Angus J, Paszat L, McKeever P, Trebilcock A, Shivji F, Edwards B. Pathways to breast cancer diagnosis and treatment: exploring the social relations of diagnostic delay. TEXTO & CONTEXTO ENFERMAGEM 2007. [DOI: 10.1590/s0104-07072007000400002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In epidemiological studies, inequitable access to breast cancer care aligns with such variables as income, age, education, ethnicity and residential location. These variables correspond to structural patterns of advantage and disadvantage, which in turn may constrain or facilitate timely access to care. The purpose of this study was to understand the complexities of women's pathways to diagnosis. Thirty-five women from diverse backgrounds and who had clinically detectable breast symptoms at time of diagnosis participated in semi-structured interviews. All were receiving or completing treatment when they participated. Data were analyzed using the strategies of induction, comparison and abduction. All of the participants described a variety of activities involved in seeking care for breast cancer. The findings illustrate how the social relations of health care, rather than simply patient or provider delay, may contribute barriers to timely diagnosis. We illustrate how women's widely differing social and material contexts offer opportunities and barriers to access.
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Affiliation(s)
| | - Lawrence Paszat
- University of Toronto; Institute for Clinical Evaluative Sciences, Canada
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