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Andersen BL, Cacioppo JT, Roberts DCDelay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes. Br J Soc Psych 34: 33-52
Abstract
Two analyses of patient delay in seeking a medical diagnosis are considered. In the first, a model of delay is presented. Specifically, delay is comprised of four stages (appraisal, illness, behavioural and scheduling delay intervals), each governed by a conceptually distinct set of decisional and appraisal processes beginning with the initial day that an unexplained symptom is detected to the day the individual appears before a physician. The second analysis is a social psychological one of the attributions individuals draw when relating their symptoms to their expectations and knowledge about physiological bodily processes. The eight principles of Psychophysiological Comparison Theory (PCT) provide the basis for clarifying the psychological processes of symptom interpretation and appraisal. Two studies were conducted with women seeking diagnostic evaluations for prevalent cancers: breast or gynaecological tumours. Regarding the delay model, results indicated that the delay intervals were independent (i.e. uncorrelated). Also, appraisal delay constituted the majority (at least 60 per cent) of the total delay. In the test of PCT, support was found across measures of symptoms, the context in which the symptoms arose, and the inferences people made about the symptoms.
... Vaccine delay may be usefully understood in relation to broader conceptual models on 'patient delay' [27]. In the context of COVID-19 vaccines, 'appraisal delay' (or decisional delay) [28] can be thought of as the question of 'should I get vaccinated'? In order to reduce decisional delay, it is particularly important for policy and health organisations to address informational barriers, including some people's perceived lack of information, the existence of conspiracy theories, and the existence of 'Covid echo chambers'. ...
Objective:
To explore UK public decisions around whether or not to get COVID-19 vaccines, and the facilitators and barriers behind participants' decisions.
Design:
This qualitative study consisted of six online focus groups conducted between 15th March and 22nd April 2021. Data were analysed using a framework approach.
Setting:
Focus groups took place via online videoconferencing (Zoom).
Participants:
Participants (n = 29) were a diverse group (by ethnicity, age and gender) UK residents aged 18 years and older.
Results:
We used the World Health Organization's vaccine hesitancy continuum model to look for, and explore, three main types of decisions related to COVID-19 vaccines: vaccine acceptance, vaccine refusal and vaccine hesitancy (or vaccine delay). Two reasons for vaccine delay were identified: delay due to a perceived need for more information and delay until vaccine was "required" in the future. Nine themes were identified: three main facilitators (Vaccination as a social norm; Vaccination as a necessity; Trust in science) and six main barriers (Preference for "natural immunity"; Concerns over possible side effects; Perceived lack of information; Distrust in government;; Conspiracy theories; "Covid echo chambers") to vaccine uptake.
Conclusion:
In order to address vaccine uptake and vaccine hesitancy, it is useful to understand the reasons behind people's decisions to accept or refuse an offer of a vaccine, and to listen to them and engage with, rather than dismiss, these reasons. Those working in public health or health communication around vaccines, including COVID-19 vaccines, in and beyond the UK, might benefit from incorporating the facilitators and barriers found in this study.
... After the year 2000, the factors that influence the duration between symptom onset and diagnosis remain poorly understood [10]- [14]. A number of theoretical frameworks have been created to conceptualize the intervals between the different phases of decision-making [8] [15]. The early models included four intervals meant representing distinct stages of the decision-making process: "appraisal", "help-seeking", "diagnostic" and "pretreatment" [16]. ...
... [3] Delay in diagnosing cancer may be broadly classified as patient-focused or healthcare provider-focused. [4] Andersen et al. [5] describe a "total patient delay" model and provide six stages of delayed symptom interpretation at the beginning of treatment. These are appraisal (lag in interpreting the symptoms); illness (delay in seeking medical attention); appointment (scheduling sluggishness is a behavioral trait), scheduling (the delay between appointment making and the first visit); and treatment (treatment postponement). ...
Timely diagnosis and early initiation of treatment of acute leukemia in children improve survival. Our study aimed to identify the factors associated with delayed diagnosis of acute leukemia in children. A prospective observational study was done at a tertiary care Superspeciality hospital in Northern India. The study included 100 children aged 0-12 years over 18 months with the diagnosis of acute leukemia. A mixed-methods technique was used, combining important variables with qualitative interviews. The primary caregivers of each patient were asked to fill out a standardized questionnaire for this study in addition to the information recorded in the case record form, Demographic, clinical, and Healthcare system data were documented. Patient, physician, and health care system factors that cause delayed diagnosis were studied. Female sex (p-value-0.003), the primary response to illness (p-value <0.001), lower socioeconomic strata, and traveling Time to the nearest health care facility of more than 20-40 minutes were significant factors identified as the reason for the delay in acute leukemia diagnosis by more than eight weeks. There is a significant time lag between the onset of the first symptom and diagnosis of acute leukemia which may adversely affect the outcome. A concerted effort to improve the health care system and raise awareness of signs and symptoms of acute leukemia among caregivers and primary care physicians is required.
... The social and cultural circumstances of the patient also seem to condition a misinterpretation of the initial symptoms of cancer. Therefore, patients from low social strata living in poverty, elderly patients living alone, institutionalised patients, homeless people, illegal immigrants, cognitively impaired patients, black, African-American or Hispanic patients (in the USA), may have difficulties in interpreting, communicating their symptoms, or even in establishing the necessary help-seeking processes [6,76,[78][79][80][81]. In the authors' experience, carcinomas that grow around teeth affecting the periodontal space cause symptoms-tooth mobility-that are often attributed by patients and even by health professionals to dental pathologies ( Figure 10). ...
Oral cancer is a growing problem, accounting for 377,713 worldwide new cases per year, and 177,757 deaths annually and representing a 5-year mortality rate close to 50%, which is a considerable mortality that has not decreased substantially in the last 40 years. The main cause of this high mortality is related to the diagnosis of a high percentage of oral cancers in advanced stages (stages III and IV) in which treatment is complex, mutilating or disabling, and ineffective. The essential cause of a cancer diagnosis at a late stage is the delay in diagnosis, therefore, the achievement of the objective of improving the prognosis of oral cancer involves reducing the delay in its diagnosis. The reasons for the delay in the diagnosis of oral cancer are complex and involve several actors and circumstances-patients, health care providers, and health services. In this paper, we present the results of a scoping review of systematic reviews on the diagnostic delay in oral cancer with the aim to better understand, based on the evidence, and discuss in depth, the reasons for this fact, and to identify evidence gaps and formulate strategies for improvement.
... Theoretical frameworks provide systematic approaches to explore health behaviours and decisions that influence the pathway to cancer diagnosis and treatment. The Model of Pathways to Treatment (Scott et al., 2013), a refinement of the General Model of Total Patient Delay (Andersen & Cacioppo, 1995), provides an framework that describes key events, processes and intervals that underpin the pathway to diagnosis of symptomatic cancer and has been influential in informing consensus statements about research into early cancer diagnosis such as the Aarhus statement (Weller et al., 2012). The Model of Pathways to treatment describes five key events: detection of bodily change(s), perception of reason(s) to discussion symptom with a healthcare practitioner (HCP), first consultation with HCP, diagnosis, and start of treatment. ...
Objective:
The objective of this study to explore experiences of patients and carers of the pathway to diagnosis and treatment of head and neck cancer (HNC), focusing on differences based on remoteness of residence.
Methods:
Patients ≥6 months post-treatment completion, and their carers, were recruited. Semi-structured interviews, guided by the Model of Pathways to Treatment as the theoretical framework, were conducted to examine pathways to treatment of HNC and facilitators and barriers to early diagnosis and treatment. Thematic analysis with an iterative and data-driven approach was used to identify themes.
Results:
A total of 39 patients and 17 carers participated in the interviews. Facilitators of timely diagnosis and treatment included a sense of urgency from health care professionals (HCPs), advocacy by the HCP or carers, and leveraging social capital. Distance to services, financial costs, and a perceived lack of emotional investment by HCPs arose as barriers to timely diagnosis and treatment. Participants were often able to rationalise that not all delays were negative, depending causes and expected impact on cancer management.
Conclusion:
The findings highlight the complex nature of factors facilitating and impeding early HNC diagnosis and treatment that may be targeted in interventions to support patients and meet important benchmarks for high-quality cancer care.
This study aims to determine the feasibility of machine learning (ML) and patient registration record to be utilised to develop an over-the-counter (OTC) screening model for breast cancer risk estimation. Data were retrospectively collected from women who came to the Hospital Univer-siti Sains Malaysia, Malaysia for breast-related problems. Eight ML models were used: k-nearest neighbour (kNN), elastic-net logistic regression, multivariate adaptive regression splines, artificial neural network, partial least square, random forest, support vector machine (SVM), and extreme gradient boosting. Features utilised for the development of the screening models were limited to information in the patient registration form. The final model was evaluated in terms of performance across a mammographic density. Additionally, the feature importance of the final model was assessed using the model agnostic approach. kNN had the highest Youden J index, precision, and PR-AUC, while SVM had the highest F2 score. The kNN model was selected as the final model. The model had a balanced performance in terms of sensitivity, specificity, and PR-AUC across the mam-mographic density groups. The most important feature was the age at examination. In conclusion, this study showed that ML and patient registration information are feasible to be used as the OTC screening model for breast cancer.
Objectives:
This study aimed to characterize 5 approaches that have been developed in research on patients and health coverage, which reveal information from the perspective of patients: (1) access to healthcare, (2) therapeutic trajectories, (3) social participation in decision making on health coverage, (4) tacit knowledge, and (5) communities of practice.
Methods:
This is a narrative literature review, based on searches performed in PubMed/MEDLINE and Web of Science, between August and December 2021. A total of 45 scientific articles were selected for analysis, which were complemented by a gray literature search that provided 6 additional manuscripts.
Results:
Improving access to health services requires an understanding of the meaning of the concept of access from the users themselves. The patient trajectory approach contributes by emphasizing that the focus of analysis must adopt the patient's perspective, given that it provides valuable information for the decision making on health coverage. In addition, the role that social participation has in the process to grant trust and legitimacy is described. Tacit knowledge makes explicit the importance of revealing it as a source of information that adds value to the decision-making process. Finally, communities of practice are described as spaces where new ways of experiencing the disease originate, as well as ways of relating to the health system and its actors.
Conclusions:
The article raises the relevance that various social actors know these approaches, as well as strategies to integrate them into the assessment processes in terms of health coverage.
Background:
Advanced stage and high mortality are characteristics of cervical cancer in developing countries. The comprehension of the diagnosis itinerary is one of the main strategies to control the disease impact.
Objectives:
To identify reasons for the delay in diagnosing symptomatic cervical cancer according to the patient's perspectives reported in qualitative studies.
Search strategy:
We searched four databases (PubMed, Embase, CINAHL, and Web of Science).
Selection criteria:
We included qualitative studies of women with advanced cervical cancer that explored their experiences before treatment. We excluded unoriginal studies, non-qualitative and duplicated studies.
Data collection and analysis:
We selected 39 articles for a full reading and included fifteen in the review. We choose the Consolidated Criteria for Reporting Qualitative Research (COREQ) for quality assessment and The Model of Pathways to Treatment to guide the codifying process.
Main results:
Four main themes emerged from the synthesis: 1) Health seeking motivators; 2) Obstacles to seeking medical care; 3) Diagnosis delay; 4) Coping with the disease. These themes were derived from patients' personal knowledge and beliefs, social relationships, socioeconomic status, and healthcare system characteristics.
Conclusions:
Individual behavior, social factors, and health care organization contribute to the delay in diagnosing advanced cervical cancer.
Objectif : Dresser un bilan des outils quantitatifs disponibles pour mesurer les représentations de la maladie et analyser leur utilisation empirique auprès de patients atteints de cancer.
Matériel et méthodes : Revue de la littérature.
Résultats : Sept outils de mesure des représentations de la maladie existent dont un spécifique au cancer. L’Illness Perception Questionnaire est utilisé dans 29 des 33 études retenues.
Conclusion : Associer ces échelles avec des méthodes reposant sur des approches davantage centrées sur le contexte socioculturel semble à privilégier.
Background
The incidence of colorectal cancer is rising in adults <50 years of age. As a primarily unscreened population, they may have clinically important delays to diagnosis and treatment. This study aimed to review the literature on delay intervals in patients <50 years with colorectal cancer (CRC), and explore associations between longer intervals and outcomes.
Methods
MEDLINE, Embase, and LILACS were searched until December 2, 2021. We included studies published after 1990 reporting any delay interval in adults <50 with CRC. Interval measures and associations with stage at presentation or survival were synthesized and described in a narrative fashion. Risk of bias was assessed using the Newcastle-Ottawa Scale, Institute of Health Economics Case Series Quality Appraisal Checklist, and the Aarhus Checklist for cancer delay studies.
Results
55 studies representing 188,530 younger CRC patients were included. Most studies used primary data collection (64%), and 47% reported a single center. Sixteen unique intervals were measured. The most common interval was symptom onset to diagnosis (21 studies; N = 2,107). By sample size, diagnosis to treatment start was the most reported interval (12 studies; N = 170,463). Four studies examined symptoms onset to treatment start (total interval). The shortest was a mean of 99.5 days and the longest was a median of 217 days. There was substantial heterogeneity in the measurement of intervals, and quality of reporting. Higher-quality studies were more likely to use cancer registries, and be population-based. In four studies reporting the relationship between intervals and cancer stage or survival, there were no clear associations between longer intervals and adverse outcomes.
Discussion
Adults <50 with CRC may have intervals between symptom onset to treatment start greater than 6 months. Studies reporting intervals among younger patients are limited by inconsistent results and heterogeneous reporting. There is insufficient evidence to determine if longer intervals are associated with advanced stage or worse survival.
Other
This study’s protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020179707).
ResearchGate has not been able to resolve any references for this publication.