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Windt S, Sims-Gould J, Mackey DC, McKay H. Older Mens' Experiences with and Preferences for Physical Activity. Can J Aging 2023; 42:576-590. [PMID: 37365164 DOI: 10.1017/s0714980823000211] [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] [Indexed: 06/28/2023] Open
Abstract
We aim to describe older mens' experiences with physical activity (PA) and their preferences for PA programs. We interviewed 14 men from a Canada-based PA intervention study called Men on the Move, and 5 men from a supplementary sample (who were not intervention participants). Content analysis was used to describe their experiences with PA and program preferences. The socio-ecological perspective and the hegemonic masculinity framework guided the research. PA barriers were low motivation, poor health, lack of time, interests other than PA and a lack of interest in PA, finances, lack of knowledge about PA, injury fear, social influences, inconvenience, weather, caregiving, built/natural environments, low-quality fitness instructors, and program structure. PA facilitators were chores, health, interest, time, motivation, social influences, active transportation, built/natural environments, good weather, program structure, and skilled/knowledgeable fitness instructors. PA program preferences were small group atmosphere, individualized attention/programming, equal number of men and women, sports programming, PA classes, and experienced instructors. Older men have distinct PA experiences. Promoting and designing programs that address their experiences may increase their PA.
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Affiliation(s)
- Sheralyn Windt
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Dawn C Mackey
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Heather McKay
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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2
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Zhou J, Chen X, Wang Z, Lin C, Zhao J, Loke AY, Li Q. Mutual communication processes within Chinese colorectal cancer patient-spousal caregiver dyads: A qualitative study of taking gender into account. Eur J Oncol Nurs 2023; 67:102427. [PMID: 37879197 DOI: 10.1016/j.ejon.2023.102427] [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: 07/22/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Mutual communication within cancer couples is a complex process. More research is needed to explore the complex process of mutual communication and its nuances presented by various factors in different culture contexts. Gender, a factor embedded in marital relationships, is an important consideration. We thus aim to explore the mutual communication process within Chinese colorectal cancer couples and take gender into account. METHODS A qualitative study was conducted by interviewing 20 colorectal cancer patients and 15 spousal caregivers. Inductive thematic analysis was used to analyze the transcripts. RESULTS Three themes (mutual communication and support interaction, communication quality, and foundation of mutual communication and collaboration) were developed. Gender was found to have specific impact on emotional disclosure and communication challenges. A preliminary framework of "smile" was constructed to demonstrate the relationship among the three themes and the relationships between the three themes and dyads' psychosocial adaptation to colorectal cancer. CONCLUSIONS Study findings demonstrate complex mutual communication processes within colorectal cancer couples and the impact of gender. The findings will contribute to developing more effective colorectal cancer couple-based mutual communication interventions. Health practitioners are suggested to improve mutual communication within colorectal cancer couples in three aspects: relational topics, emotional disclosure and communication skills. Guiding couples to deal with each theme and the relationship among the themes simultaneously is helpful for them to return and smile to their normal life.
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Affiliation(s)
- Junrui Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Xuan Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Zhiming Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Chunyan Lin
- Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Jie Zhao
- Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon Hong Kong, China
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China; Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China.
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3
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Zhou J, Wang Z, Chen X, Li Q. Gender Differences in Psychosocial Outcomes and Coping Strategies of Patients with Colorectal Cancer: A Systematic Review. Healthcare (Basel) 2023; 11:2591. [PMID: 37761788 PMCID: PMC10530630 DOI: 10.3390/healthcare11182591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Gender is an important factor impacting cancer experience. This review mainly aimed to summarize colorectal cancer (CRC) patients' gender differences in psychosocial outcomes and coping strategies. (2) Methods: Relevant studies were searched for in four electronic databases from 2007 to July 2023. And manual searching was performed on the included studies' reference lists to identify additional eligible studies. (3) Results: A total of 37 eligible articles were included in this review. These studies were conducted in 19 countries, and they targeted CRC patients at various treatment stages. Significant results showed that female patients tended to have more psychological distress, complex social functioning, and less sexual distress and to choose more positive coping strategies than male patients. But there was no gender difference in psychosocial outcomes and/or coping strategies in some studies, which implied that gender similarity also existed. (4) Conclusions: The findings support the fact that there are both gender differences and similarities in CRC patients' psychosocial outcomes and coping strategies. A perspective beyond the simple masculine-feminine binary improved our in-depth understanding of gender tendency. Importantly, taking gender tendency into account is critical for medical staff to provide more personalized support and communication interventions.
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Affiliation(s)
| | | | | | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (J.Z.); (Z.W.); (X.C.)
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4
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Arapi A, Vellone E, Ivziku D, Duka B, Taci D, Notarnicola I, Stievano A, Prendi E, Rocco G, De Maria M. Psychometric Characteristics of the Self-Care of Chronic Illness Inventory in Older Adults Living in a Middle-Income Country. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4714. [PMID: 36981630 PMCID: PMC10048512 DOI: 10.3390/ijerph20064714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Chronic illness requires numerous treatments and self-care is essential in the care process. Evaluation of self-care behaviors facilitates the identification of patients' needs and optimizes education and care processes. This study aimed to test the psychometric characteristics (validity, reliability, and measurement error) of the Albanian version of the Self-Care of Chronic Illness Inventory (SC-CII). Patients with multiple chronic conditions and caregivers were recruited in outpatient clinics in Albania. The patients completed the SC-CII, which includes three scales: self-care maintenance, self-care monitoring, and self-care management. Factorial validity was tested for each scale, with confirmatory factor analysis. Reliability was evaluated with the composite coefficient, Cronbach's alpha, and the global reliability index for multidimensional scales. The construct validity was tested using hypothesis testing and known differences between groups. The measurement error was tested to assess responsiveness to changes. The self-care maintenance and self-care monitoring scales showed a unidimensional factorial structure, while the self-care management scale showed a bidimensional structure. Reliability estimates were adequate for all reliability coefficients. Construct validity was supported. The measurement error was adequate. The Albanian version of the SC-CII shows good psychometric properties in the Albanian sample.
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Affiliation(s)
- Alta Arapi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Dhurata Ivziku
- Degree Course in Nursing, UniCamillus International Medical University, 00131 Rome, Italy
- Department of Healthcare Professions, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
| | - Blerina Duka
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Dasilva Taci
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Ippolito Notarnicola
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Alessandro Stievano
- Centre of Excellence for Nursing Scholarship, Order of Nurses of Rome, 00173 Rome, Italy
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Emanuela Prendi
- Department of Biomedical Sciences, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Gennaro Rocco
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
- Centre of Excellence for Nursing Scholarship, Order of Nurses of Rome, 00173 Rome, Italy
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
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5
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Jones D, Di Martino E, Bradley SH, Essang B, Hemphill S, Wright JM, Renzi C, Surr C, Clegg A, Neal R. Factors influencing symptom appraisal and help-seeking of older adults with possible cancer: a mixed-methods systematic review. Br J Gen Pract 2022; 72:BJGP.2021.0655. [PMID: 35995576 PMCID: PMC9423047 DOI: 10.3399/bjgp.2021.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/24/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The cancer burden falls predominantly on older (≥65 years) adults. Prompt presentation to primary care with cancer symptoms could result in earlier diagnosis. However, patient symptom appraisal and help-seeking decisions involving cancer symptoms are complex and may be further complicated in older adults. AIM To explore the effect of older age on patients' appraisal of possible cancer symptoms and their decision to seek help for these symptoms. DESIGN AND SETTING Mixed-methods systematic review. METHOD MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science Core Collection, ASSIA, the ISRCTN registry, and the National Institute for Health and Care Excellence were searched for studies on symptom appraisal and help-seeking decisions for cancer symptoms by adults aged ≥65 years. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-Analysis guidelines. RESULTS Eighty studies were included with a total of 32 995 participants. Studies suggested a possible association between increasing age and prolonged symptom appraisal interval. Reduced knowledge of cancer symptoms and differences in symptom interpretation may contribute to this prolonged interval. In contrast, in the current study a possible association was found between increasing age and prompt help-seeking. Themes affecting help-seeking in older adults included the influence of family and carers, competing priorities, fear, embarrassment, fatalism, comorbidities, a desire to avoid doctors, a perceived need to not waste doctors' time, and patient self-management of symptoms. CONCLUSION This review suggests that increasing age is associated with delayed cancer symptom appraisal. When symptoms are recognised as potentially serious, increasing age was associated with prompt help-seeking although other factors could prolong this. Policymakers, charities, and GPs should aim to ensure older adults are able to recognise potential symptoms of cancer and seek help promptly.
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Affiliation(s)
- Daniel Jones
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | | | | | - Blessing Essang
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Scott Hemphill
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | | | | | - Andrew Clegg
- Academic Unit for Ageing & Stroke Research, University of Leeds, Leeds
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Shattuck EC, Perrotte JK, Daniels CL, Xu X, Sunil TS. Signaling sickness: the role of recalled sickness behavior and psychosocial factors in shaping communication style. EVOLUTION MEDICINE AND PUBLIC HEALTH 2021; 9:221-231. [PMID: 34408880 PMCID: PMC8364984 DOI: 10.1093/emph/eoab017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/09/2021] [Indexed: 11/13/2022]
Abstract
Background and objectives Active infection results in several outward signs in humans, including visible symptoms, changes in behavior and possible alterations in skin color and gait. A potential adaptive function of these indicators is to signal distress and elicit care from close others. We hypothesized that sickness behavior, a suite of stereotypical changes in mood and behavior, also serves to communicate health status to others. We further hypothesized that such outward signals/cues of health status would vary based on context and sociocultural norms. Methodology We explored self-reported, recalled sickness behavior, communication style, demographics and theoretically relevant cultural factors in a large national US sample (n = 1259) using multinomial probit regressions. Results In accordance with predictions, relatively few participants were willing to talk or complain about sickness to strangers. Self-reported, recalled sickness behavior was associated with some communication styles but attention received from others was more consistently associated with potential signaling. Several cultural factors, including stoicism and traditional machismo, were also associated with different sickness signaling styles. Conclusions and implications These preliminary, self-reported data lend some tentative support to the sickness behavior signaling hypothesis, though experimental or observational support is needed. The role of cultural norms in shaping how such signals are transmitted and received also deserves further attention as they may have important implications for disease transmission. Lay Summary Evolutionary medicine hypothesizes that signs and symptoms of infectious disease—including sickness behavior—have adaptive functions, one of which might be to reliably signal one’s health status to others. Our results suggest that evolved signals like these are likely shaped by cultural factors.
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Affiliation(s)
- Eric C Shattuck
- Institute for Health Disparities Research, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Jessica K Perrotte
- Department of Psychology, Texas State University, 614 N. Guadalupe St. #253, San Marcos, TX, USA
| | - Colton L Daniels
- Department of Sociology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Xiaohe Xu
- Department of Sociology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Thankam S Sunil
- Department of Public Health, University of Tennessee, Knoxville, 1914 Andy Holt Ave, Knoxville, TN 37996, USA
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7
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Bernhardson BM, Tishelman C, Rasmussen BH, Hajdarevic S, Malmström M, Overgaard Hasle TL, Locock L, Eriksson LE. Sensations, symptoms, and then what? Early bodily experiences prior to diagnosis of lung cancer. PLoS One 2021; 16:e0249114. [PMID: 33780498 PMCID: PMC8007036 DOI: 10.1371/journal.pone.0249114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 03/11/2021] [Indexed: 11/26/2022] Open
Abstract
Lung cancer (LC) generally lacks unique core symptoms or signs. However, there are a multitude of bodily sensations that are often non-specific, not easily understood, and many times initially not recognized as indicative of LC by the affected person, which often leads to late diagnosis. In this international qualitative study, we inductively analyzed retrospective accounts of 61 people diagnosed with LC in Denmark, England and Sweden. Using the bodily sensations they most commonly spoke about (tiredness, breathlessness, pain, and cough), we constructed four sensation-based cases to understand the pre-diagnostic processes of reasoning and practice triggered by these key indicators of LC. We thereafter critically applied Hay's model of sensations to symptoms transformation, examining its central concepts of duration, disability and vulnerability, to support understanding of these processes. We found that while duration and disability are clearly relevant, vulnerability is more implicitly expressed in relation to perceived threat. Tiredness, even when of long duration and causing disability, was often related to normal aging, rather than a health threat. Regardless of duration, breathlessness was disturbing and threatening enough to lead to care-seeking. Pain varied by location, duration and degree of disability, and thus also varied in degree of threat perceived. Preconceived, but unmet expectations of what LC-related cough and pain would entail could cause delays by misleading participants; if cough lasted long enough, it could trigger health care contact. Duration, disability, and sense of threat, rather than vulnerability, were found to be relevant concepts for understanding the trajectory to diagnosis for LC among these participants. The process by which an individual, their family and health care providers legitimize sensations, allowing them to be seen as potential symptoms of disease, is also an essential, but varying part of the diagnostic processes described here.
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Affiliation(s)
- Britt-Marie Bernhardson
- Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Carol Tishelman
- Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services (SLSO), Stockholms County Council (SLL), Stockholm, Sweden
| | - Birgit H. Rasmussen
- Department of Health Sciences, Lund University, Lund, Sweden
- The Institute for Palliative Care, Lund University and Region, Skåne, Sweden
| | | | - Marlene Malmström
- Department of Health Sciences, Lund University, Lund, Sweden
- The Institute for Palliative Care, Lund University and Region, Skåne, Sweden
| | - Trine Laura Overgaard Hasle
- Department of Public Health, Research Centre for Cancer, Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
- Nuffield Department of Primary Care Health Sciences, Health Experiences Research Group, University of Oxford, Oxford, United Kingdom
| | - Lars E. Eriksson
- Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of Health Sciences, University of London, London, United Kingdom
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
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8
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Höhn A, Gampe J, Lindahl-Jacobsen R, Christensen K, Oksuyzan A. Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalisation at ages 60+ in Denmark. J Epidemiol Community Health 2020; 74:573-579. [PMID: 32303595 PMCID: PMC7337231 DOI: 10.1136/jech-2019-213435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/18/2020] [Accepted: 03/12/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND It remains unclear whether women's greater primary healthcare use reflects a lower treatment-seeking threshold or a health disadvantage. We address this question by studying primary healthcare use surrounding a major health shock. METHODS This cohort study utilises routinely-collected healthcare data covering the Danish population aged 60+ years between 1996 and 2011. Using a hurdle model, we investigate levels of non-use and levels of primary healthcare use before and after first inpatient hospitalisation for stroke, myocardial infarction (MI), chronic obstructive pulmonary disease (COPD) and gastrointestinal cancers (GIC). RESULTS Before hospitalisation, irrespective of cause, men were more likely than women to be non-users of primary healthcare (OR (95% CI): stroke 1.802 (1.731 to 1.872); MI 1.841 (1.760 to 1.922); COPD 2.160 (2.028 to 2.292); GIC 1.609 (1.525 to 1.693)). Men who were users had fewer primary healthcare contacts than women (proportional change (eβ) (95% CI): stroke 0.821 (0.806 to 0.836); MI 0.796 (0.778 to 0.814); COPD 0.855 (0.832 to 0.878); GIC 0.859 (0.838 to 0.881)). Following hospitalisation, changes in the probability of being a non-user (OR (95% CI): stroke 0.965 (0.879 to 1.052); MI 0.894 (0.789 to 0.999); COPD 0.755 (0.609 to 0.900); GIC 0.895 (0.801 to 0.988)) and levels of primary healthcare use (eβ (95% CI): stroke 1.113 (1.102 to 1.124); MI 1.112 (1.099 to 1.124); COPD 1.078 (1.063 to 1.093); GIC 1.097 (1.079 to 1.114)) were more pronounced among men. Gender differences widened after accounting for survival following hospitalisation. CONCLUSION Women's consistently higher levels of primary healthcare use are likely to be explained by a combination of a lower treatment-seeking threshold and a health disadvantage resulting from better survival in bad health.
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Affiliation(s)
- Andreas Höhn
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK .,Max Planck Institute for Demographic Research, Rostock, Germany.,Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense C, Denmark
| | - Jutta Gampe
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Rune Lindahl-Jacobsen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense C, Denmark.,Interdisciplinary Centre on Population Dynamics (Cpop), University of Southern Denmark, Odense C, Denmark
| | - Kaare Christensen
- Max Planck Institute for Demographic Research, Rostock, Germany.,Danish Aging Research Center, University of Southern Denmark, Odense C, Denmark
| | - Anna Oksuyzan
- Max Planck Institute for Demographic Research, Rostock, Germany
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Shattuck EC, Perrotte JK, Daniels CL, Xu X, Sunil TS. The Contribution of Sociocultural Factors in Shaping Self-Reported Sickness Behavior. Front Behav Neurosci 2020; 14:4. [PMID: 32038193 PMCID: PMC6992553 DOI: 10.3389/fnbeh.2020.00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
Sickness behavior is an evolutionarily conserved phenomenon found across a diverse range of animals involving a change in motivational priorities to theoretically maximize energetic investment in immune function and recovery. Typical components of sickness behavior include reduced sociability and activity, changes in diet, and depressed affect. Importantly, however, sickness behavior appears to be subject to other demands of life history in animal models, including reproduction and offspring survival. Thus, "feeling sick" is often context dependent with possible effects on morbidity and mortality. While humans may not always face the same life history trade-offs, sociocultural norms and values may similarly shape sickness behavior by establishing internalized parameters for "socially appropriate sickness." We explore the role of these factors in shaping sickness behavior by surveying a national U.S. sample (n = 1,259). Self-reported and recalled sickness behavior was measured using the SicknessQ instrument, which has previously been validated against experimentally induced sickness behavior. After post-stratification weighting and correction for Type I error, generalized linear models showed that sickness behavior is significantly affected by various factors across sex and racial/ethnic groupings. Income below the national mean (b = 1.85, adj. p = 0.025), stoic endurance of pain and discomfort (b = 1.61, adj. p < 0.001), and depressive symptomology (b = 0.53, adj. p < 0.001) were each associated with greater sickness behavior scores. Familism (b = 1.59, adj. p = 0.008) was positively associated with sickness behavior in men, but not women. Endurance of pain and discomfort was associated with greater sickness behavior in Whites only (b = 1.94, adj. p = 0.002), while familism approached significance in African Americans only (b = 1.86, adj. p = 0.057). These findings may reflect different social contexts of sickness across demographic groups, which may in turn have important implications for pathogen transmission and recovery times, potentially contributing to health disparities.
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Affiliation(s)
- Eric C. Shattuck
- Institute for Health Disparities Research, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Jessica K. Perrotte
- Department of Psychology, Texas State University, San Marcos, TX, United States
| | - Colton L. Daniels
- Department of Sociology, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Xiaohe Xu
- Department of Sociology, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
- School of Public Administration, Sichuan University, Chengdu, China
| | - Thankam S. Sunil
- Institute for Health Disparities Research, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
- Department of Sociology, College of Liberal and Fine Arts, The University of Texas at San Antonio, San Antonio, TX, United States
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Incidence and predictors of drug overdoses among a cohort of >10,000 patients treated for substance use disorder. Drug Alcohol Depend 2020; 206:107714. [PMID: 31753733 DOI: 10.1016/j.drugalcdep.2019.107714] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Drug overdoses remain a significant public health burden throughout the world. This study assessed the incidence and predictors of non-fatal and fatal drug overdoses among patients with an opioid use, treated for drug use disorders (DUD) at public treatment centers in Denmark. METHODS A consecutive cohort of patients (n = 11,199) were tracked from date of first registered enrollment between the year 2000 and 2010 to first registered drug overdose, death or December 31st 2010, whichever occurred first. Competing-risks regression models were fitted to estimate the sub hazard ratios (SHRs) of non-fatal and fatal drug overdoses and confounding risk factors. RESULTS A total of 3186 (28%) patients experienced a non-fatal drug overdose during follow-up, and 572 (6%) died from an overdose. Use of benzodiazepines (SHR: 1.15 95% CI 1.03, 1.28) was significantly associated with non-fatal overdose. Intravenous drug use and previous hospitalization for a non-fatal overdose increased the risk of later non-fatal (SHR: 1.57 95% CI 1.42, 1.73) and fatal overdoses (SHR: 1.43 95% CI 1.12, 1.82). CONCLUSIONS Patients who use opioids remain at risk of overdoses for a long time after discharge from drug treatment. Besides relevant monitoring and psychosocial support in opioid maintenance treatment, there is a need for informing and educating opioid users in risk factors and preventive measures in settings where they are often difficult to access for traditional treatment services.
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Rural women: Most likely to experience food insecurity and poor health in low- and middle-income countries. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2019. [DOI: 10.1016/j.gfs.2019.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Bussey LG, Sillence E. The role of internet resources in health decision-making: a qualitative study. Digit Health 2019; 5:2055207619888073. [PMID: 31741741 PMCID: PMC6843735 DOI: 10.1177/2055207619888073] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Internet resources remain important for health information and advice but their specific role in decision-making is understudied, often assumed and remains unclear. In this article, we examine the different ways in which internet resources play a role in health decision-making within the context of distributed decision-making. Methods We conducted semi-structured interviews with 37 people in the United Kingdom who reported using the internet in relation to decision-making, and representing a range of long- and short-term health conditions. The interviews focused on decision-making activities across different settings and in relation to different stakeholders to understand how internet resources play a role in these activities. We carried out a thematic analysis of the interviews. Results We identified three main ways in which internet resources played a role in health decision-making. A supportive role (as a decision crutch), a stimulating role (as a decision initiator), and an interactional role (impacting on the doctor–patient relationship). These three roles spanned different resources and illustrated how the decision-making process can be impacted by the encounters people have with technology – specifically internet based health resources – in different ways and at different time points. Conclusions Examining health decisions with respect to internet resources highlights the complex and distributed nature of decision-making alongside the complexity of online health information sourcing. We discuss the role of internet resources in relation to the increasing importance of online personal experiences and their relevance within shared decision-making.
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Affiliation(s)
- Lauren Georgia Bussey
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, Tees Valley, UK
| | - Elizabeth Sillence
- Psychology and Communication Technologies Lab, Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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13
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Simpson P, Richards M. Reflexivity denied? The emotional and health-seeking resources of men facing disadvantage. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:900-916. [PMID: 30790300 DOI: 10.1111/1467-9566.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Based on focus group discussions of self-generated photographs of individuals aged 19-67 resident in urban Northwest England, this article examines the health narratives of men facing disadvantage because of economic hardship and/or mental health difficulty (mhd). In contrast to stereotypes of men as uncomfortable with emotions linked to vulnerability, we explore how such men can develop within self-help groups the kind of emotional resources that encourage health-seeking behaviours. Our argument contrasts with theories that risk denying/diminishing working-class men's emotional reflexivity or that frame reflexivity (thought on feelings and behaviour to effect life changes) as individualised and more available to middle-class (younger) men. We argue that participant accounts indicate development of more collective emotional and epistemic resources from a position of subordinated masculinity. This argument challenges stereotypes of working-class men as lacking in knowledge/skill in health and self-care. Collective reflexivity over health/wellbeing was particularly visible in three main accounts that emerged during focus groups: involvement in self-help 'communities of practice', use of local aesthetic spaces and negotiation with/qualified challenge to healthy eating discourse.
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Affiliation(s)
- Paul Simpson
- Applied Health and Social Care, Edge Hill University, Lancashire, UK
| | - Michael Richards
- Applied Health and Social Care, Edge Hill University, Lancashire, UK
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14
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Cunningham Y, Wyke S, Blyth KG, Rigg D, Macdonald S, Macleod U, Harrow S, Robb KA, Whitaker KL. Lung cancer symptom appraisal among people with chronic obstructive pulmonary disease: A qualitative interview study. Psychooncology 2019; 28:718-725. [PMID: 30693608 PMCID: PMC6492269 DOI: 10.1002/pon.5005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 01/21/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The incidence of lung cancer is four times higher in people with chronic obstructive pulmonary disease (COPD) compared with the general population. Promotion of a shorter time from symptom onset to presentation is one potential strategy for earlier lung cancer diagnosis, but distinguishing respiratory symptoms can be difficult. We investigated how the experience of COPD influences symptom appraisal and help seeking for potential lung cancer symptoms. METHODS We conducted qualitative interviews with men (n = 17) and women (n = 23) aged 40 to 83 years with COPD. Topic guides drew on the integrated symptom-response framework and covered symptom experience, interpretation, action, recognition, help seeking, evaluation, and reevaluation. We used the framework method to analyse the data. RESULTS Participants said that they attributed chest symptoms to their COPD; no other cause was considered. Participants said that family/friends noticed changes in their symptoms and encouraged help seeking. Others felt isolated by their COPD because they could not get out, were fatigued, or were embarrassed. Participants visited health professionals frequently, but increased risk of lung cancer was not discussed. CONCLUSIONS Our study provides insight into different levels of influence on symptom appraisal and targets for intervention. Greater awareness of increased lung cancer risk and support to act on symptom changes is essential and could be achieved through a concerted information campaign. Health professionals working with people with COPD could also optimise appointments to support symptom appraisal of potential lung cancer symptoms.
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Affiliation(s)
| | - Sally Wyke
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Kevin G. Blyth
- Pleural Disease UnitQueen Elizabeth University HospitalGlasgowUK
- Institute of Infection, Immunity & InflammationUniversity of GlasgowGlasgowUK
| | - Douglas Rigg
- Keppoch Medical PracticePossilpark Health & Care CentreGlasgowUK
| | - Sara Macdonald
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Una Macleod
- Faculty of Health SciencesHull York Medical SchoolHullUK
| | - Stephen Harrow
- PET/CT CentreBeatson West of Scotland Cancer CentreGlasgowUK
| | - Kathryn A. Robb
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
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15
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Oksuzyan A, Dańko MJ, Caputo J, Jasilionis D, Shkolnikov VM. Is the story about sensitive women and stoical men true? Gender differences in health after adjustment for reporting behavior. Soc Sci Med 2019; 228:41-50. [PMID: 30875543 DOI: 10.1016/j.socscimed.2019.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/28/2019] [Accepted: 03/03/2019] [Indexed: 10/27/2022]
Abstract
Research indicates that women have higher levels of physical disability and depression and lower scores on physical performance tests compared to men, while the evidence for gender differences in self-rated health is equivocal. Scholars note that these patterns may be related to women over-reporting and men under-reporting health problems, but gender differences in reporting behaviors have not been rigorously tested. Using Wave 1 of the Survey of Health, Ageing and Retirement in Europe (SHARE), the present study investigates the extent to which adjusting for differences in reporting behavior modifies gender differences in general health. We also examine whether men and women's reporting behaviors are consistent across different levels of education. After adjusting for reporting heterogeneity, gender differences in both poor and good health widened. However, we found no clear gender-specific patterns in reporting either poor or good health. Our findings also do not provide convincing evidence that education is an important determinant of general health reporting, although the female disadvantage in poor health and the male advantage in good health were more apparent in lower than higher education groups at all ages. The results challenge prevailing stereotypes that women over-report and men under-report health problems and highlight the importance of attending to health problems reported by women and men with equal care.
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Affiliation(s)
- Anna Oksuzyan
- Max Planck Institute for Demographic Research, Konrad-Zuse Str.1, 18057, Rostock, Germany.
| | - Maciej J Dańko
- Max Planck Institute for Demographic Research, Konrad-Zuse Str.1, 18057, Rostock, Germany
| | - Jennifer Caputo
- Max Planck Institute for Demographic Research, Konrad-Zuse Str.1, 18057, Rostock, Germany
| | - Domantas Jasilionis
- Max Planck Institute for Demographic Research, Konrad-Zuse Str.1, 18057, Rostock, Germany; Demographic Research Centre, Vytautas Magnus University, Jonavos Str. 66, 44138, Kaunas, Lithuania
| | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Konrad-Zuse Str.1, 18057, Rostock, Germany; National Research University Higher School of Economics, Bolshoy Tryokhsvyatitelsky Pereulok 3, 109028, Moscow, Russian Federation
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16
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Macdonald S, Conway E, Bikker A, Browne S, Robb K, Campbell C, Steele RJ, Weller D, Macleod U. Making sense of bodily sensations: Do shared cancer narratives influence symptom appraisal? Soc Sci Med 2019; 223:31-39. [PMID: 30703697 DOI: 10.1016/j.socscimed.2018.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/04/2018] [Accepted: 12/23/2018] [Indexed: 01/22/2023]
Abstract
Though new or altered bodily sensations are a common occurrence they rarely transition to biomedically defined symptoms. When they do, sensations are subject to an appraisal process that can culminate in help-seeking. The transition has particular relevance for cancer diagnoses. Studies of 'symptom appraisal' in cancer patients typically conclude that failure to regard sensations as serious or 'symptom misattribution' results in lengthier help-seeking intervals. Though multiple influences on appraisal processes are acknowledged, including the socio-cultural context, detailed description and analyses of how socio-cultural factors shape appraisal is lacking. In this paper we explore one substantial component of the sociocultural context, namely, publicly recognised shared cancer narratives, and their impact on appraisal. We undertook a secondary analysis of 24 interviews with Scottish colorectal cancer patients originally completed in 2006-2007. Our analysis showed that fear, death and severity dominated cancer narratives and were frequently restated throughout interviews. Yet, early bodily changes were often mild and vague, were commonly experienced in the context of 'feeling well' and failed to match preconceived ideas of what cancer 'feels like'. Moreover, few perceived themselves to be 'at risk' of cancer and diagnoses were characterised as 'shocking' events. Participants engaged in self-monitoring strategies and severe or painful changes prompted help-seeking. Far from misattributing symptoms, responses to bodily changes were sensible and measured; responses are particularly apt in relation to current policy rhetoric, which urges measured use of services. Our findings have resonance across healthcare settings as patients are required to negotiate a narrow and challenging space when making decisions to seek help. There is a pressing need for a more realistic approach to symptom appraisal in order to reduce help-seeking intervals. Future awareness campaigns should emphasise the importance of vague/minor bodily changes although this will necessitate discussions with health professionals on referral thresholds to achieve earlier detection.
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Affiliation(s)
- Sara Macdonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK.
| | - Elaine Conway
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Susan Browne
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Kathryn Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Robert Jc Steele
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
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17
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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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18
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Emery JD, Murray SR, Walter FM, Martin A, Goodall S, Mazza D, Habgood E, Kutzer Y, Barnes DJ, Murchie P. The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer. Thorax 2019; 74:362-370. [PMID: 30630891 PMCID: PMC6484693 DOI: 10.1136/thoraxjnl-2018-212506] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 12/11/2022]
Abstract
Background International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms. Methods Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates. Results We randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation. Conclusions A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk. Trial registration number Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.
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Affiliation(s)
- Jon D Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sonya R Murray
- Department of General Practice, The Medical School, University of Western Australia, Perth, Australia
| | - Fiona M Walter
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Emily Habgood
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne Kutzer
- Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - David John Barnes
- Royal Prince Alfred Hospital, Newtown, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Murchie
- The Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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19
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Tookey S, Renzi C, Waller J, von Wagner C, Whitaker KL. Using the candidacy framework to understand how doctor-patient interactions influence perceived eligibility to seek help for cancer alarm symptoms: a qualitative interview study. BMC Health Serv Res 2018; 18:937. [PMID: 30514369 PMCID: PMC6278141 DOI: 10.1186/s12913-018-3730-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND 'Candidacy' is concerned with the way people consider their eligibility for accessing health services. We used the Candidacy Framework to explore how the doctor-patient relationship can influence perceived eligibility to visit their General Practitioner (GP) among people experiencing cancer alarm symptoms. METHODS We carried out a secondary analysis of qualitative interviews with 29 women and 33 men, aged ≥50 years experiencing cancer alarm symptoms, recruited through primary care. Interviews focused on symptom experience, help-seeking and primary care use. Framework analysis was used to analyse transcripts with a focus on GP-patient interactions. RESULTS Perceived (im)permeability of services acted as a barrier to help-seeking, due to limited availability of appointments, time-limited communication and difficulties asserting candidacy. There was also a focal role of communication in building a positive doctor-patient relationship, with some participants describing resisting offers of appointments as a result of previous negative GP adjudication. These factors not only influenced the current consultation but had longer-term consequences for future consultation. CONCLUSIONS Candidacy provides a valuable theoretical framework to understand the interactional factors of the doctor-patient relationship which influence perceived eligibility to seek help for possible cancer alarm symptoms. We have highlighted areas for targeted interventions to improve patient-centred care and improve earlier diagnosis.
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Affiliation(s)
- Sara Tookey
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
| | - Cristina Renzi
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
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