Same-day diagnosis of symptomatic breast problems: Psychological impact and coping strategies

Abstract

'One-stop' clinics offering same-day investigation and diagnosis of symptomatic breast problems are becoming increasingly available. This randomized controlled trial compared the one-stop system (n = 416) with conventional arrangements (n = 375) involving two appointments and a delay before diagnosis is available. Semi-structured interviews and the HADS and EORTC QLQ-C30 were used to assess psychological distress at first clinic attendance and at follow-up. Visual analogue scales addressed worry, impact on daily functioning and perceived satisfaction with care. The brief COPE identified coping strategies used before and after diagnosis. Levels of psychological distress at first clinic attendance were high. Six days later the one-stop group showed significantly lower levels of anxiety (p 0.05), but women with cancer were more distressed than those still awaiting diagnosis. Eight weeks later, speedier diagnosis of cancer was associated with higher levels of depressive symptoms (p 0.05). Each strategy on the brief COPE was used by a higher percentage of women diagnosed with cancer than by women diagnosed with a benign condition. Whilst speedier diagnosis reduces psychological distress for women with benign conditions, results suggest a possible detrimental effect for those with cancer. Effective coping and the appropriate provision of psychological care in one-stop clinics warrant further investigation.