The Model of Pathways to Treatment: Conceptualization and integration with existing theory

Scott, Suzanne E.; Walter, Fiona M; Webster, Andrew; Sutton, Stephen; Emery, Jon

doi:10.1111/j.2044-8287.2012.02077.x

Cited by 260 publications

(427 citation statements)

References 86 publications

(169 reference statements)

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“…[1][2][3][4]7,10,11,[32][33][34][35][36][37] Interestingly, the categories of reasons that emerged from the present study mapped almost directly onto a general psychological model of responses to negative events-Crisis Decision Theory 30 -which has not previously been used as a framework for understanding medical care avoidance. Crisis Decision Theory posits that people respond to negative events first by appraising the severity of threat, next by identifying available response options, and lastly by evaluating available response options.…”

Section: Discussionmentioning

confidence: 90%

Why do People Avoid Medical Care? A Qualitative Study Using National Data

2014

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BACKGROUND: Many studies have examined barriers to health care utilization, with the majority conducted in the context of specific populations and diseases. Less research has focused on why people avoid seeking medical care, even when they suspect they should go. OBJECTIVE: The purpose of the study was to present a comprehensive description and conceptual categorization of reasons people avoid medical care. DESIGN: Data were collected as part of the 2008 Health Information National Trends Survey, a cross-sectional national survey. PARTICIPANTS: Participant-generated reasons for avoiding medical care were provided by 1,369 participants (40% male; M age =48.9; 75.1% non-Hispanic white, 7.4% non-Hispanic black, 8.5% Hispanic or Latino/ a). MAIN MEASURES: Participants first indicated their level of agreement with three specific reasons for avoiding medical care; these data are reported elsewhere. We report responses to a follow-up question in which participants identified other reasons they avoid seeking medical care. Reasons were coded using a general inductive approach. KEY RESULTS: Three main categories of reasons for avoiding medical care were identified. First, over one-third of participants (33.3% of 1,369) reported unfavorable evaluations of seeking medical care, such as factors related to physicians, health care organizations, and affective concerns. Second, a subset of participants reported low perceived need to seek medical care (12.2%), often because they expected their illness or symptoms to improve over time (4.0%). Third, many participants reported traditional barriers to medical care (58.4%), such as high cost (24.1%), no health insurance (8.3%), and time constraints (15.6%). We developed a conceptual model of medical care avoidance based on these results. CONCLUSIONS: Reasons for avoiding medical care were nuanced and highly varied. Understanding why people do not make it through the clinic door is critical to extending the reach and effectiveness of patient care, and these data point to new directions for research and strategies to reduce avoidance.

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Section: Discussionmentioning

confidence: 90%

Why do People Avoid Medical Care? A Qualitative Study Using National Data

2014

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“…Perhaps the most influential approach (Andersen et al 1995) subdivides time to treatment into appraisal, illness, behavioural, scheduling and treatment 'delay' periods, each associated with specific appraisal and decisional processes. Scott et al (2013) have criticised this model for failing to adequately take into account the perspectives of those who subsequently learn that they have developed dangerous or fatal lesions. The issues which they raise include patients initially explaining subsequently identified melanoma symptoms in other ways, attempting to self-manage and responding to emotions.…”

Section: Melanoma Self-surveillance and Treatment 'Delay'mentioning

confidence: 99%

“…Patients who now know that they are living with a dangerous or terminal cancer may underestimate the signal detection challenge which they and/or their doctors had previously faced. As argued by Scott (2013) those who normalise signs which turn out to be melanoma symptoms, or accept medical reassurance, do not 'delay' treatment-seeking because they did not contemporaneously see themselves as being at risk. Perhaps more uncommonly, individuals who subsequently learn that they have developed a dangerous melanoma may delay going to the doctor because they prioritise more pressing concerns such as caring for a sick relative, thereby intentionally taking a risk which, with the benefit of hindsight, they may regret.…”

mentioning

confidence: 99%

‘I am not someone who gets skin cancer’: risk, time and malignant melanoma

Topping

Nkosana-Nyawata

Heyman

2013

Health, Risk & Society

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ABSTRACT'Delay' is a term used in the cancer literature since the 1930s to describe the period between self-detection of a concerning sign of possible disease and presentation to a health professional. This linguistic choice carries an implication of blame for apparent failure to manage a risk appropriately, drawing attention away from the contemporaneous perspectives of those who respond to suspicious indicators more or less quickly. We present findings from a grounded theory study of accounts given by 45 patients about their slower or quicker journeys to a diagnosis of cutaneous 2 malignant melanoma, a cancer which can 'hide in plain sight'. There has been little research exploring in qualitative detail patients' perspectives on their decision-making about what subsequently turn out to have been signs of this most risky of skin cancers.The findings frame referral time-lapses in terms of normalisation of symptoms, sometimes buttressed by reassurance derived from health promotion messages, disconfirmation of patients' concerns by their general practitioners and prioritisation of other life concerns. We argue that a shared sense of urgency surrounding melanoma self-referral derives from a clinical representation of current knowledge which conceals numerous evidential uncertainties.

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“…An accurate risk perception is central to shaping appropriate responses to a health threat [45][46][47]. The term optimistic bias is sometimes used to describe an unrealistic health-risk perception, whereby individuals tend to interpret symptoms as innocuous, as opposed to life-threatening [44,48].…”

Section: The Intervention Recipientsmentioning

confidence: 99%

Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial

O’Brien

McKee

Mooney

et al. 2014

Patient Education and Counseling

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CitationImproving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial. Methods: This multi-site, randomized controlled trial was conducted on 1947 patients with a diagnosis of ACS. Both groups received usual in-hospital education.Participants randomized to the intervention group received a 40-minute one to one individualized education session, delivered using motivational interviewing techniques. The intervention was reinforced one month and six months later.Knowledge, attitudes and beliefs were measured using the ACS Response Index. A total of 1,136 patients (control, n=551; intervention, n=585) completed the questionnaire at baseline, 3 and 12 months. Data were analysed using repeated measures analysis of variance. Ethical approval was obtained. Results:There was a significant effect of the intervention on mean knowledge (p<0.001), attitude (p=0.003) and belief (p<0.001) scores at 3 and 12 months. Conclusion:Ensuring patients retain information post education has always been difficult to attain. This study demonstrated that patient education using motivational interviewing techniques and an individualized approach has the potential to alter knowledge, attitudes and beliefs about ACS among a high risk population.Practice Implications: This relatively short, simple and effective educational intervention could be delivered by nurses in multiple settings.

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The Model of Pathways to Treatment: Conceptualization and integration with existing theory

Cited by 260 publications

References 86 publications

Why do People Avoid Medical Care? A Qualitative Study Using National Data

Why do People Avoid Medical Care? A Qualitative Study Using National Data

‘I am not someone who gets skin cancer’: risk, time and malignant melanoma

Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial

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