Predicting women's delay in seeking medical care after discovery of a lump in the breast: the role of personality and behavior patterns.

Experts agree that the detection of breast cancer in the early stages significantly enhances the chance of recovery. Although most women are aware of this, many still delay in seeking medical care. This study examined the relationship between four personality measures--health locus of control, hopelessness, repression-sensitization, and trait anxiety--and women's delay in approaching a doctor after discovering a lump in the breast. The authors also examined the relationship between delay and behavioral manifestations of body awareness representing the extent of the women's "contact" with their bodies. Five self-report inventories were administered to 62 women who had come for a biopsy as a result of a suspected breast tumor. No significant correlations were found between the personality variables and the time that elapsed before the women approached a doctor. On the other hand, a significant correlation was found between delay in seeking medical care and the measure of the women's "contact" with her body. Possible explanations to account for these results are suggested and their application to planning health education programs is discussed.     

Effects of contacts between cancer patients on their psychosocial problems

In this article results are presented of a study on the effects of patient -to-patient support on the psychosocial problems of cancer patients. Data were collected at two points in time from samples of lymphoma and breast cancer patients in accordances with a quasi-experimental, non-equivalent control group design. Regular contacts between fellow patients decreased negative feelings (depression, anxiety and psychological complaints) and increased self-esteem. This was true especially for patient under treatment and those, whose illness had recurred.Regular contacts with other breast cancer patients decreased feelings of uncertainty especially if they had not received relevant information from their doctor.Uncertainty was also reduced in patients with Hodgkin's disease who indicated having received relevant information from their doctor. However, for those Hodgkin's disease patients who indicated that they did not receive relevant information from their specialist, having only a few contacts with fellow sufferers led to an increase in feelings of uncertainty.     

A qualitative study of delay among women reporting symptoms of breast cancer.

BACKGROUND: Delayed presentation of symptomatic breast cancer of three months or more is associated with lower survival rates from the disease, yet 20% to 30% of women wait at least three months before consulting their general practitioner (GP) with breast symptoms. AIM: To explore the factors that influence GP consultation by women with breast cancer symptoms. DESIGN OF STUDY: Qualitative analysis of semi-structured interviews. SETTING: Forty-six women with newly diagnosed breast cancer, selected from 185 women recruited to a larger study. METHOD: Interviews were conducted eight weeks after diagnosis of breast cancer, comparing two groups of women divided according to the extent of delay between onset of symptoms and seeking medical care. Fifteen women had sought advice from their GP within two weeks of symptom discovery ('non-delayers' and 31 had waited 12 weeks or more before seeing their doctor ('delayers'). RESULTS: Women with breast symptoms who presented promptly to GPs recognised the seriousness of the symptom they had discovered more quickly than delayers. Perception of seriousness was influenced by the nature of the initial symptom and how far it matched the individual's expectations of breast cancer as a painless breast lump. Other factors affecting help-seeking included attitudes to GP attendance, beliefs about the consequences of cancer treatment, and perceptions of other priorities taking precedence over personal health. CONCLUSIONS: This analysis suggests that women need further information about the different types of breast cancer symptoms to assist symptom recognition, as well as encouragement to seek medical advice if a symptom is ambiguous. In addition, women may benefit from greater awareness of the benefits of early detection and reassurance about the improvements in quality of breast cancer care.     

Improving utilization of breast and cervical cancer screening in your office practice.

It has been well documented that early detection and early intervention for breast and cervical cancer saves lives. However, the challenge is to ensure that physicians'' practices are effective in implementing the standard guidelines for screening and that all women are screened and undergo appropriate follow-up. Early detection and intervention are imperative since African-American women are twice as likely as European-American women to die from breast cancer even though the incidence of breast cancer is lower. African-American women have fewer mammograms and are being diagnosed later after metastases have occurred. Studies also show that women are more likely to have mammograms if their physicians so advise. However, the most common reason women give for not obtaining mammograms is, "My doctor never recommended it." By using a simple critical path analysis tool to systematically evaluate an office practice and by implementing practical, simple principles, a physician can increase utilization of breast and cervical cancer screening.     

Patient–doctor continuity and diagnosis of cancer: electronic medical records study in general practice

Background

Continuity of care may affect the diagnostic process in cancer but there is little research.

Aim

To estimate associations between patient–doctor continuity and time to diagnosis and referral of three common cancers.

Design and setting

Retrospective cohort study in general practices in England.

Method

This study used data from the General Practice Research Database for patients aged ≥40 years with a diagnosis of breast, colorectal, or lung cancer. Relevant cancer symptoms or signs were identified up to 12 months before diagnosis. Patient–doctor continuity (fraction-of-care index adjusted for number of consultations) was calculated up to 24 months before diagnosis. Time ratios (TRs) were estimated using accelerated failure time regression models.

Results

Patient–doctor continuity in the 24 months before diagnosis was associated with a slightly later diagnosis of colorectal (time ratio [TR] 1.01, 95% confidence interval [CI] =1.01 to 1.02) but not breast (TR = 1.00, 0.99 to 1.01) or lung cancer (TR = 1.00, 0.99 to 1.00). Secondary analyses suggested that for colorectal and lung cancer, continuity of doctor before the index consultation was associated with a later diagnosis but continuity after the index consultation was associated with an earlier diagnosis, with no such effects for breast cancer. For all three cancers, most of the delay to diagnosis occurred after referral.

Conclusion

Any effect for patient–doctor continuity appears to be small. Future studies should compare investigations, referrals, and diagnoses in patients with and without cancer who present with possible cancer symptoms or signs; and focus on ‘difficult to diagnose’ types of cancer.     

‘What's in a face?’ The role of doctor ethnicity,age and gender in the formation of patients’ judgements: an experimental study

BACKGROUND: Research has shown that doctor's make judgements about patients on the basis of their demographic characteristics. Little is known about how patients judge their doctors. AIM: The present study aimed to explore the impact of a doctor's ethnicity, age and gender on patients' judgements in the setting of a general practice consultation. METHODS: The study involved an experimental factorial design using vignettes with patients receiving one of eight photos of a doctor who varied in terms of ethnic group (Asian versus White), age (older versus younger) and gender (male versus female). Six general practices in South West London took part and 309 patients (response rate = 77%) rated the doctor in terms of the expected behaviour of the doctor, the expected behaviour of the patient and the patient ease with the doctor. RESULTS: The results showed that in terms of the impact of ethnic group, the Asian doctor and White doctor received comparable ratings for most questions; however, the Asian doctor was rated as being more likely to explore emotional aspects of health than the White doctor. Differences for age and gender were more profound. In particular, both the younger doctor and the female doctor were judged to have a better personal manner, better technical skills, better explanation skills, to be more likely to explore emotional aspects of health and empower the patient. Patients also stated that they were more likely to have faith in their diagnoses, advice and to comply with treatment and preferred both the younger and female doctors for a physical examination. In addition, younger doctors were deemed to be more likely to refer a patient to see a hospital specialist and female doctors were seen to be more likely to suggest complementary therapy. CONCLUSION: A doctor's age and gender have a stronger impact on a patient's judgements than their ethnicity.     

Doctor-patient relationship as motivation and outcome: examining uses of an Interactive Cancer Communication System

OBJECTIVE: To examine how the pre-existing doctor-patient relationship predicts conceptually distinct service use within an Interactive Cancer Communication System (ICCS) for underserved women with breast cancer and in turn how service utilization influences the doctor-patient relationship. METHODS: Study sample included 231 recently diagnosed, lower income breast cancer patients. Participants were provided a free computer, Internet access and training in how to use an ICCS called the Comprehensive Health Enhancement Support System (CHESS) "Living with Breast Cancer" program. Survey data was collected at pre-test and 4-months after using the system, and use data about how women used the system was also collected. RESULTS: The only statistically significant predictor of service use was that patients with a more negative appraisal about the doctor-patient relationship used the Ask an Expert service more frequently, and there were trends toward a more negative appraisal of the doctor-patient relationship being associated with higher use of Information and Interactive services. Conversely, there was a trend toward a more positive appraisal predicting higher use of the Discussion Group service. In terms of statistically significant effects, more frequent utilization of Information services was associated with a more positive appraisal of the doctor relationship. CONCLUSION: While a more negative perception of the doctor-patient relationships at pre-test was associated with higher use of most of the conceptually distinct services within this ICCS, use of the Information services was associated with having a more positive appraisal of the doctor-patient relationship at post-test suggesting that high-quality information on the Internet can serve to improve patients' satisfaction with their doctor.     

Opportunistic health promotion: do patients like it?

In a five doctor general practice 100 adults attending routine surgeries were given questionnaires to assess the influence of discussing health promotion on their satisfaction with the consultation. Health promotion topics were discussed in 74% of the 86 consultations analysed. Of these consultations, blood pressure was mentioned in the largest number (48%) and breast self-examination in the smallest (6%). Patient satisfaction was not significantly influenced by the inclusion or omission of such topics. The highest mean satisfaction score was for those discussing smoking and the lowest for those discussing alcohol. Most patients (84%) found discussion of health promotion helpful and felt comfortable (62%); only two patients felt uncomfortable doing so.     

Time and the general practitioner: the patient's view

Patient satisfaction with the amount of time general practitioners allow them has been questioned. This paper reports the analysis of a questionnaire answered by 1,112 patients in 25 practices in Britain. The questionnaire explored the patients' assessment of the appropriateness of the length of the consultation and their ability to communicate their problem to the doctor.

While most patients (91 per cent) felt that the consultation was long enough, there were a number of patients who were dissatisfied with the length of the consultation and their ability to communicate their problem to the doctor; dissatisfaction increased with shorter booked appointment times, with younger patients, when fewer previous visits to the doctor had been made and when the psychological component of the case was greater. It is particularly disturbing that more than 50 per cent of women between the ages of 15 and 44 years experienced difficulty in telling the doctor about their problem.

     

Putting on the style: what patients think of the way their doctor dresses.

The aim of this study was to determine how acceptable patients found different styles of doctors' dress and whether patients felt that a doctor's style of dress influenced their respect for his or her opinion. A total of 475 patients from five general practices in Lothian were surveyed using photographs of different styles in a male and female doctor and questions about their attitudes to doctors' dress in general. Overall, patients seemed to favour a more formal approach to dress, with the male doctor wearing a formal suit and tie and the female doctor in a white coat scoring the most high marks. This was particularly true of older patients and those in social classes 1 and 2. The male doctor wearing a tweed jacket and informal shirt and tie scored fewer low marks and this was therefore the least disliked of the outfits. There was a marked variation between preferences of patients registered with different practices. When asked, 28% of patients said they would be unhappy about consulting one of doctors shown, usually the ones who were informally dressed. However, some patients said they would dislike their doctor wearing a white coat. Although there are more important attributes for a general practitioner than the way he or she dresses, a majority of patients (64%) thought that the way their doctor dressed was very important or quite important. Given that 41% of the patients said they would have more confidence in the ability of one of the doctors based on their appearance it would seem logical for doctors to dress in a way that inspires confidence.(ABSTRACT TRUNCATED AT 250 WORDS)     

Users and non-users of doctors — implications for self-care

Sixty patients who visited their general practitioner were matched with 60 patients registered with the same doctor, who were of the same sex and in the same ten-year age group, and who had not visited the doctor for at least one year, but had recently experienced symptoms similar to those presented by the attending patients.

Comparison of the 60 pairs revealed the following differences, all substantial although not all statistically significant. The patients who visited the doctor perceived themselves as less healthy, fewer had attempted self-treatment, more reported serious personal problems, and fewer reported obstacles to visiting the doctor.

Differences between the pairs were negligible for total number of current ailments, effectiveness of self-treatment, if used, optimism about the healing powers of doctors, and fear of troubling their doctor with trivia.

     

Breast self-examination in women 35 and older: A prospective study

A correlational study was conducted to identify attitudinal variables specified by the Health Belief Model that were related to frequency and total performance (frequency and proficiency) of breast self-examination (BSE). The probability sample consisted of 362 women, ages 35 and over, who were initially contacted via random digit dialing. Data were collected during in-home interviews by trained graduate assistants and by telephone interview 1 year later. Results supported the ability of past performance, perceived barriers, and knowledge to predict current total performance (combined frequency and proficiency). In addition, frequency for breast self-examination was predicted by past frequency, barriers, health motivation, control, being taught by a doctor, confidence, having BSE procedure checked, benefits, and susceptibility. Results lend support to use of attitudinal and experiential variables in predicting women's actual behaviors in relation to breast self-examination.This research project was supported by the NCNR, NIH, under Grant 2 R23 NU 01285-02.     

Patients' attitudes to chaperones

In a survey of 200 female patients attending a five-man practice in a health centre, 75 per cent of the respondents stated that they would like to be offered a chaperone at pelvic examinations. Only six per cent would accept the offer if the examination was performed by their own doctor and 17 per cent if a different doctor examined them. Patients expressing a definite wish for a chaperone were significantly younger and were less likely to have had a previous pelvic examination. Those who definitely did not want one had usually had a pelvic examination before and had been registered with their doctor for significantly longer. These findings may have implications for the conduct of pelvic examination in young women by trainee and locum general practitioners.     

Patients'' views of the consultation: comparison of a prison and general practice population.

Prisoners' perceptions of why they consulted the doctor, how ill they thought they were and what happened during the consultation were studied in Bedford prison using a questionnaire. Patients' perceptions were compared before and after the consultation and with the perception of the doctor. The figures from this study were compared with comparable groups in a similar general practice survey. Prisoners perceived themselves to be more ill than comparable groups living in the community and both doctor and prisoners perceived that the prisoners received less reassurance. Prisoners were less likely to attend the doctor because their treatment had not worked, or because the doctor had asked them to return than comparable groups living in the community. The perception of the doctor and the prisoners about what occurred in the consultation diverged. The doctors perceived that they provided more advice and support than the prisoners felt they received. These perceptions may reflect a more difficult doctor-patient relationship and poorer continuity of care in prison medicine. These problems might be overcome if the prison medical service were run by the National Health Service and prison doctors had no role in the management of prisoners.     

Talking matters: abused women's views on disclosure of partner abuse to the family doctor and its role in handling the abuse situation

OBJECTIVE: We aimed to explore what women valued most in disclosing partner abuse to their doctor and whether disclosure played a role in handling their abuse situation. METHODS: A qualitative method was used to understand abused women's views and experiences with disclosure to their family doctor. Thirty-six women were interviewed within 4 weeks after disclosure to their family doctor. RESULTS: Most women went to see the doctor for some medical complaint, and only three women planned to disclose the abuse. Twenty-five women valued most their doctor's communicative approach with empathy or empowering and nine women valued most the instrumental approach. Eight women of the latter group wanted this combined with a communicative approach. After disclosure to the family doctor, a group of women (n=20) perceived a real change in their possibilities to handle their situation. They appeared to be in a position we named: 'in transition', a state in which they started or continued a process of change. Another group of women (n=13) appeared to be in a 'locked-up' position, a state without any prospect on change, feeling out of control and fearing the abuser. Three women reacted reserved towards change. CONCLUSION: A communicative approach, providing empathy and empowerment, is important to women in disclosing partner abuse. More than half of the women perceived possibilities for a change. PRACTICE IMPLICATIONS: Talking about abuse is an important step in a woman's process of change. Doctors should acknowledge the advantage of their position as a professional confidant and ask women about abuse.     

抑郁症患者的求医行为及影响因素分析

目的 了解抑郁症患者的求医行为及影响因素。方法 对抑郁症患者及陪护人进行问卷调查。结果 求医首诊机构的选择与疾病特点及对疾病的认识有关,患者年龄及陪护人的文化程度与求医方式有关,求医行为延误时间与患者的年龄、文化程度有关。结论 影响抑郁症求医行为的主要因素为症状特点及陪护人的文化程度。     

Factors influencing mothers'' decisions to consult a general practitioner about their children''s illnesses.

BACKGROUND. In the management of childhood illness only a small proportion of symptoms result in a medical consultation. AIM. This pilot study set out to assess the influence of sociodemographic factors, social network, reason of choice of doctor and contact with allied health professionals on mothers' decisions to consult a general practitioner about their children's illnesses. METHOD. In one suburb of Melbourne, Australia all mothers with children aged 11 to 26 months were identified from the maternal and child health centre register. Mothers were invited for interview and if they attended were asked to keep a health diary for their child for four weeks. Logistic regression was used to test a multivariate model of factors predicting consultation with the general practitioner. RESULTS. A total of 150 mothers were identified. Interviews were carried out with 81% of target mothers and diary data collected for 72% of target children. Over the four-week diary period, consultation rates with the general practitioner were significantly higher if symptoms were recorded on 15 days or more, or the general practitioner had been recommended by a friend or was the mother's own doctor before the child's birth. Contact with a maternal and child health nurse was also a significant predictor of medical contact. Contact with friends and relatives, whether or not the study child was the first child in the family, mother's education, husband's occupational status or contact with a chemist were not significantly related to medical consultation rates. CONCLUSION. Choice of doctor (current doctor same as doctor before birth of child, or doctor recommended by a friend) resulted in significantly more consultations as did contact with a maternal and child health nurse. These factors would seem to require further study and inclusion in future models of consulting behaviour.     

Self-rated breast cancer risk among women reporting a first-degree family history of breast cancer on office screening questionnaires in routine medical care: the role of physician-delivered risk feedback.

PURPOSE: We investigated whether risk-related feedback delivered by one's primary care physician is associated with self-ratings of risk among women found to have a first-degree family history of breast cancer on office screening questionnaires. METHODS: Design: Mailed survey of women registered with the Cancer Genetics Network having a first-degree family history of breast cancer. Eligibility: Completion of primary care-based family history screening within the past year. Independent variable: presence of physician feedback about breast cancer risk. Dependent variable: self-rated breast cancer risk. Modifying variable: trust in one's doctor. RESULTS: Three hundred one women met eligibility criteria (73% minimum response rate); feedback was associated with rating one's risk to be "high" in both crude and multivariate analysis. (ORadj = 2.38; 95% CI = 1.30, 4.38). Higher levels of trust in the physician were associated in a dose-dependent fashion with the strength of association between feedback and self-rating one's risk to be high. CONCLUSIONS: Physician feedback following the identification of a first-degree family history of breast cancer appears to influence whether or not women categorize themselves to be at high risk and trust is an important modifier of this association.     

An exploratory study of cancer patients' views on doctor-provided and independent written prognostic information

This is the first study to systematically compare cancer patients' views on prognostic information provided by their doctor and written prognostic information obtained from a major cancer organisation (The Cancer Council New South Wales). Twenty-six adult patients who were recruited from a cancer clinic and an oncologist's private rooms completed a questionnaire and an interview. Participants varied in their views about the relative accuracy of doctor-provided and independent written information and responses to contradictory information. Participants' need for certainty, trust in their doctor and concerns about the effect of undermining that trust, appear to influence whether they would discuss independent information with their doctor, and how they would deal with conflicting information. Although preliminary, this study has identified a number of issues that may need to be taken into account both by people developing written prognostic information and by doctors, who may need to address patient concerns about trust to assist patients to deal with conflicting information.     

Seeing two doctors at once in general practice

We report the reactions of 250 patients who saw two doctors together, a general-practitioner trainer and a vocational trainee, when they came to a general practice for consultation.

Over 80 per cent were neutral and the remainder were almost equally divided between those who preferred to see two doctors and those who preferred to see their own doctor alone.

Selected favourable statements outnumbered adverse comments by about ten to one, although allowance must be made for the desire of patients to please their doctor.