RESUMEN
BACKGROUND: Little is known about how patients decide whether or not to undergo colorectal cancer screening. Although low screening rates evidence the outcome of these decisions, the processes patients use to balance benefits, risks, and costs with their own values and preferences are unclear. To increase screening rates, and ultimately save lives, it is important for providers to be aware of how patients make screening decisions. OBJECTIVES: The purpose of this study was to identify patterns of patient colorectal cancer screening decisions that might be supported by health care providers. POPULATION: In this study, we focused on people from Central Kentucky--a region with historically low screening rates. METHOD: We interviewed patients using a semi-structured format. Three members of the research team independently analyzed each interview transcript for factors that influenced the decision, and a pictorial representation of each decision process, based on Kurt Lewin's theory of decision making, was constructed for each participant. The individual decision processes were compared with identify patterns. RESULTS: Seventeen women and 13 men made up the sample. We discerned 7 decision patterns. CONCLUSIONS: This research documents 7 patterns and identifies common driving and restraining forces.
Asunto(s)
Actitud Frente a la Salud , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/psicología , Toma de Decisiones , Tamizaje Masivo/psicología , Participación del Paciente/estadística & datos numéricos , Anciano , Femenino , Humanos , Kentucky , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Educación del Paciente como Asunto , Satisfacción del Paciente/estadística & datos numéricos , Relaciones Médico-Paciente , Encuestas y CuestionariosRESUMEN
The lifetime risk of developing colorectal cancer is 2.5 to 5% in the general population. Colorectal screening can prevent mortality, and there are a number of screening methods, ranging from noninvasive to highly invasive. Although recommendations have been widely disseminated in the media and scientific journals, screening usage is low. In this project, the authors examine the factors that influence individuals' decisions regarding colorectal screening. They conducted semistructured interviews with 30 people (13 men and 17 women) selected to provide a maximum variation sample. They categorized factors into the following themes: concern for one's personal well-being, competing demands, preparing for the procedure, the screening process, gender concerns, fear of having cancer, feeling healthy, cost, the experiences of others, and turning 50 years old.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Toma de Decisiones , Examen Físico/estadística & datos numéricos , Femenino , Humanos , Entrevistas como Asunto , Kentucky , Masculino , Persona de Mediana EdadRESUMEN
Women in the USA are at disproportionate risk of dying from a myocardial infarction (MI), of suffering disabilities following an MI, and of reinfarcting and dying within a year of their initial MI. Various explanations, including women's older age at clinical manifestation of coronary heart disease (CHD) and higher likelihood of co-morbidities, have been offered for women's heightened risk of poor outcomes. Less frequently, research has focused on examining women's prolonged time elapse between symptom onset and biomedical treatment, a phenomenon that renders women less likely to undergo lifesaving reperfusion strategies. [1] To explore factors and circumstances that may shape CHD time to treatment, 40 middle age and older women living in Kentucky, USA, half with diagnosed CHD and half with chronic conditions considered to be risk factors for CHD, participated in a series of in-depth interviews. While much of the existing CHD literature implicates individual responsibility as the determining feature in time to treatment, these women's narratives suggested that treatment decisions inextricably are linked to broader social and structural constraints. Such supra-individual forces that shape the CHD experiences of women include the social construction of "standard" cardiac symptoms based on male norms that ultimately confuse symptom detection, women's negative encounters with health care providers who discount their knowledge, the competing social demands women face when threatened by a serious illness, and structural barriers delimiting women's health care choices.