Patient Delay In Seeking Treatment Research Articles

Mycobacterium tuberculosis lineage 7 strains are associated with prolonged patient delay in seeking treatment for pulmonary tuberculosis in Amhara Region, Ethiopia.

Recent genotyping studies of Mycobacterium tuberculosis in Ethiopia have reported the identification of a new phylogenetically distinct M. tuberculosis lineage, lineage 7. We therefore investigated the genetic diversity and association of specific M. tuberculosis lineages with sociodemographic and clinical parameters among pulmonary TB patients in the Amhara Region, Ethiopia. DNA was isolated from M. tuberculosis-positive sputum specimens (n=240) and analyzed by PCR and 24-locus mycobacterial interspersed repetitive unit-variable-number tandem-repeat (MIRU-VNTR) analysis and spoligotyping. Bioinformatic analysis assigned the M. tuberculosis genotypes to global lineages, and associations between patient characteristics and genotype were evaluated using logistic regression analysis. The study revealed a high diversity of modern and premodern M. tuberculosis lineages, among which approximately 25% were not previously reported. Among the M. tuberculosis strains (n=138) assigned to seven subgroups, the largest cluster belonged to the lineage Central Asian (CAS) (n=60; 26.0%), the second largest to lineage 7 (n=36; 15.6%), and the third largest to the lineage Haarlem (n=35; 15.2%). Four sublineages were new in the MIRU-VNTRplus database, designated NW-ETH3, NW-ETH1, NW-ETH2, and NW-ETH4, which included 24 (10.4%), 18 (7.8%), 8 (3.5%), and 5 (2.2%) isolates, respectively. Notably, patient delay in seeking treatment was significantly longer among patients infected with lineage 7 strains (Mann-Whitney test, P<0.008) than in patients infected with CAS strains (adjusted odds ratio [AOR], 4.7; 95% confidence interval [CI], 1.6 to 13.5). Lineage 7 strains also grew more slowly than other M. tuberculosis strains. Cases of Haarlem (OR, 2.8; 95% CI, 1.2 to 6.6) and NW-ETH3 (OR, 2.8; 95% CI, 1.0 to 7.3) infection appeared in defined clusters. Intensified active case finding and contact tracing activities in the study region are needed to expedite diagnosis and treatment of TB.

Appraisal of breast cancer symptoms by Iranian women: entangled cognitive, emotional and socio-cultural responses.

Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.

Somatic Awareness and Symptom Attribution in Ischemic Stroke Patients

Patient delay in seeking treatment for stroke symptoms is a major factor in morbidity and mortality due to stroke. Every 4 minutes, someone dies of a stroke, and 54% of those deaths occur before the patient reaches the hospital. The aim of this study was to determine the relationship of somatic awareness and symptom attribution to treatment-seeking behaviors in ischemic stroke patients. This was a descriptive, correlational pilot study. This study was carried out in three tertiary-care hospitals in Philadelphia, Pennsylvania, and Binghamton, New York. Twenty patients diagnosed with ischemic stroke were included. The Modified Somatic Perception Questionnaire measured somatic awareness, and the Symptom Interpretation Questionnaire measured symptom attribution. There was no relationship identified between somatic awareness or symptom attribution and treatment-seeking behaviors. Significance was identified, using t-test comparisons, between physical attribution scores and insurance status (p = .038) and family history of stroke (p = .026). Significant correlations, r = .386 and r = .433, respectively, were identified between somatic awareness and symptom attribution and education. Somatic awareness and symptom attribution were not found to be significantly correlated to time to care. These results must be tempered with the knowledgethat the data were derived from a small sample and that some data were missing due to a lack of recall. Significance was identified, in a comparison of the group means, involving insurance status and family history of stroke, to somatic awareness and symptom attribution. Significant correlation was identified between education and these factors. Future research involving these factors, using a revised methodology, should be considered.

The impact on anxiety and perceived control of a short one-on-one nursing intervention designed to decrease treatment seeking delay in people with coronary heart disease

Patient delay in seeking treatment for acute coronary syndrome symptoms remains a problem. Thus, it is vital to test interventions to improve this behavior, but at the same time it is essential that interventions not increase anxiety. To determine the impact on anxiety and perceived control of an individual face-to-face education and counseling intervention designed to decrease patient delay in seeking treatment for acute coronary syndrome symptoms. This was a multicenter randomized controlled trial of the intervention in which anxiety data were collected at baseline, 3-months and 12-months. A total of 3522 patients with confirmed coronary artery disease were enrolled; data from 2597 patients with anxiety data at all time points are included. The intervention was a 45 min education and counseling session, in which the social, cognitive and emotional responses to acute coronary syndrome symptoms were discussed as were barriers to early treatment seeking. Repeated measures analysis of covariance was used to compare anxiety and perceived control levels across time between the groups controlling for age, gender, ethnicity, education level, and comorbidities. There were significant differences in anxiety by group (p = 0.03). Anxiety level was stable in patients in the control group, but decreased across time in the intervention group. Perceived control increased across time in the intervention group and remained unchanged in the control group (p = 0.01). Interventions in which cardiac patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms.

Determinants of patient delay in seeking treatment among pulmonary tuberculosis cases in a government specialist hospital in Ibadan, Nigeria

Patients delay in seeking care increases the transmission of pulmonary tuberculosis and hence the burden of the disease. This study investigates the pattern and determinants of patients delay in seeking treatment among pulmonary tuberculosis cases attending a Government Chest Clinic in Ibadan, Nigeria. A descriptive cross sectional study was employed. A face to face interview of 102 newly diagnosed tuberculosis patients at the clinic was conducted using a structured questionnaire. The mean age of respondents was 45.4 ±13.5 years and 61(59.8%) were females. The overall median delay in seeking treatment among study subjects was 60 days (range 3 to 180 days), with 61.8% patients delaying for more than 30 days. Binary logistic regression model showed that female sex (OR=5.3), place of residence (OR=3.9), outside Ibadan vs. within Ibadan), age group >45 vs. ≤45 years (OR=2.4) and reported stigma (OR=7.6) were significantly associated with longer patients delay. The results showed that delay among patients in seeking care is common and some groups of patients may be experiencing problems in seeking care in our environment.

Persistent comorbid symptoms of depression and anxiety predict mortality in heart disease

Incident anxiety and depression are associated separately with cardiac events and mortality in patients after acute coronary syndromes, but the influence of persistent comorbid depression and anxiety on mortality remains unknown. The purpose of this study was to determine the prevalence of comorbid persistent depressive and anxious symptoms in individuals with ischemic heart disease and to evaluate effects on mortality. Prospective, longitudinal cohort design in the context of a randomized trial to decrease patient delay in seeking treatment for ischemic heart symptoms (PROMOTION trial) was used, with twelve-month follow-up of 2325 individuals with stable ischemic heart disease. Participants were assessed on enrollment and at 3 months using the Multiple Adjective Affect Checklist and the Brief Symptom Inventory for depressive and anxious symptoms, respectively. At 3 months, 608 individuals (61.7%) reported persistent symptoms of depression, anxiety, or both. Three hundred seventy-nine (42.5%) and 1056 (45.4%) had persistent anxious and depressive symptoms, respectively. Those with persistent, comorbid symptoms had higher mortality compared to others (p=.029). The combined presence of anxious and depressive symptoms contributed significantly to mortality when compared to symptom-free participants (OR 2.35, 95% CI 1.23-4.47, p=.010). The presence of persistent depressive symptoms only and persistent anxious symptoms only were not associated with death, when other demographic and clinical variables were considered. Persistent symptoms of anxiety and depression increased substantially the risk of death in patients with ischemic heart disease. Future research into shared and unique pathways and treatments is needed.

Abstract 1822: Impact on Anxiety of an Education and Counseling Intervention Designed to Decrease Treatment Seeking Delay in Response to Acute Coronary Syndrome (ACS) Symptoms

Background: Patient delay in seeking treatment for ACS symptoms remains a substantial problem with most people delaying more than 2 hours before they seek treatment. Thus, it is vital to test interventions to improve this behavior, but at the same time it is essential that such interventions not increase anxiety. Given that these interventions seek to decrease patient denial of the seriousness of symptoms, it is possible that they may increase anxiety. Purpose: To determine the impact on anxiety of an individual face-to-face education and counseling intervention designed to decrease patient delay in seeking treatment for ACS symptoms. Methods: This was a multicenter randomized (intervention vs. usual care) controlled trial of the intervention in which anxiety data were collected (using the Multiple Affect Adjective Checklist) at baseline, 3-months and 12-months after the intervention. A total of 3522 patients with confirmed coronary artery disease (CAD) who were at risk for ACS were enrolled; data from 2597 patients with complete anxiety data at all three time points are included here. There were no differences in patients completing all three time points and those who did not. The intervention consisted of a 45 minute education and counseling session, reinforced by a phone call one month later in which the social, cognitive and emotional responses to ACS symptoms were discussed as were barriers to early treatment seeking. Repeated measures ANCOVA was used to compare anxiety levels across time between the groups controlling for age and gender. Results: There were significant differences in anxiety by group (p = 0.014). Anxiety level was stable in patients in the control group, but decreased by 10% at 3 months in the intervention group and remained at this reduced level at 12 months. Conclusion: An intervention designed to reduce patient delay in seeking treatment for ACS symptoms did not increase anxiety, but rather was associated with a reduction in anxiety. Interventions in which CAD patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms.

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research.

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research.

The J-Delay scale: a measure of the likelihood of patient delay in breast cancer.

Patient delay in seeking treatment for breast cancer is a major contributing factor to morbidity and mortality. No instruments have previously been developed to predict the likelihood of patient delay. This report describes the development and testing of the J-Delay scale, designed to estimate a woman's risk of making the judgment to delay versus to seek immediate evaluation of self-discovered breast symptoms that might signal breast cancer. The J-Delay scale items were developed in four qualitative studies (28 focus groups, combined N = 147 women). The J-Delay scale was tested in 2 large, community-based samples varying across age, income, and ethnicity (combined N = 1,290). Content validity was supported by narrative analysis. Criterion validity was supported by the correct prediction of patient delay in 69%-86% of surveyed and interviewed women with symptoms of 3 months' or more duration. Internal consistency reliability was .83 in English samples (n = 596 and 352) and .81 in a Spanish sample (n = 222). Test-retest reliability after 3-4 months (n = 251) was supported by consistent assignment in 88.8% of cases. The J-Delay is a valid and reliable tool to identify women at risk for patient delay. Women identified as likely to delay medical attention must be targeted for early detection interventions focused on patient delay.

Reducing patient delay in seeking treatment

Articles| November 01 1997 Reducing patient delay in seeking treatment K Dracup; K Dracup Search for other works by this author on: This Site PubMed Google Scholar CW Bryan-Brown CW Bryan-Brown Search for other works by this author on: This Site PubMed Google Scholar Am J Crit Care (1997) 6 (6): 415–417. https://doi.org/10.4037/ajcc1997.6.6.415 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Cite Icon Cite Get Permissions Citation K Dracup, CW Bryan-Brown; Reducing patient delay in seeking treatment. Am J Crit Care 1 November 1997; 6 (6): 415–417. doi: https://doi.org/10.4037/ajcc1997.6.6.415 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAmerican Journal of Critical Care Search Advanced Search You do not currently have access to this content.

Beyond sociodemographics: Factors influencing the decision to seek treatment for symptoms of acute myocardial infarction

OBJECTIVE: To determine the impact of sociodemographic, clinical, cognitive, emotional, and social factors on patient delay in seeking treatment for symptoms of acute myocardial infarction. DESIGN: Multicenter descriptive survey. SETTING: Forty-three hospitals in North America. SUBJECTS: Two hundred and seventy-seven patients with confirmed acute myocardial infarction enrolled in a thrombolytic clinical trial. OUTCOME MEASURES: Time from symptom onset to arrival at the hospital for treatment. RESULTS: Patients with longer delays were older, had lower incomes, had diabetes, experienced their symptoms at home, did not appraise their symptoms as serious or originating from the heart, had symptoms that were intermittent in nature, waited to see whether symptoms disappeared, worried about troubling others, feared what might happen if they sought treatment, and did not realize the importance of symptoms. CONCLUSION: Patient appraisal of seriousness of symptoms is related to delay, whereas severity, nature, and knowledge of symptoms are not related. Cognitive and emotional responses affect patients' decisions to seek treatment. (Heart Lung ® 1997;26:253-62)

Marital status, delay in seeking treatment and survival from breast cancer

This study examined 10-year survival following a breast cancer diagnosis among 910 married and 351 widowed white women after adjusting for the effects of age, socio-economic status (SES), stage of disease and delay in seeking treatment for symptoms. All breast cancer patients were treated at M.D. Anderson Hospital and Tumor Institute in Houston, Texas between 1949 and 1968. Marital status, age, SES, delay and stage were all univariate predictors of survival. Widowed patients were less likely to survive than married patients. Multivariate analyses using a Cox regression technique did not detect an effect of delay on survival when stage and the other variables were included. However, marital status differences in survival remained when all the other variables were included in the model. These data suggest that marital status differences in survival cannot be accounted for by patient delay in seeking treatment for breast cancer symptoms.