Seeking Treatment For Symptoms Research Articles

A cross-sectional study of ethnicity-based differences in treatment seeking for symptoms of acute coronary syndrome.

Patient-related delays in acquiring medical care for symptoms of acute coronary syndrome remain unacceptably long. Many clinical and sociodemographic characteristics associated with treatment-seeking delay are known; however, ethnicity has not been extensively evaluated. The purpose of this study was to examine ethnicity-based differences in the time-to-treatment-seeking intervals of patients experiencing symptoms of acute coronary syndrome. Data for this descriptive study were collected for the larger Acute Coronary Syndrome Care in Emergency Departments (ASCEND) study. The larger study is a prospective, observational study in which patients presenting to hospital emergency departments and triaged as having symptoms suggestive of acute coronary syndrome are identified. The primary outcome of this study, the time-to-treatment-seeking interval, was defined as the time between symptom onset and treatment seeking. The predictor variable, ethnicity, was measured with self-reported data and categorised as Chinese, South Asian, or 'Other' ethnic group. Participants in the 'Other' ethnic group were predominantly of European ancestry. Univariate and multivariate analyses were undertaken, along with nonparametric testing. The study sample consisted of 419 participants: 36 Chinese, 126 South Asian, and 257 'Other' participants. The median time-to-treatment-seeking interval, for the total sample, was 180 minutes. A Kruskal-Wallis test demonstrated no statistically significant differences in the time-to-treatment-seeking intervals by ethnicity. No ethnicity-based differences in the time-to-treatment-seeking intervals for symptoms of acute coronary syndrome were found. It is possible that Chinese and South Asian patients living in western countries are more aware of the potential signs and symptoms of acute coronary syndrome or feel more confident to access healthcare services than they have been previously.

Symptoms of Reported Sexually Transmitted Infections, Misconceptions about Its Transmission, Treatment Seeking Behaviour-Voices of Brothel-Based Female Sex Workers (FSWs)-A Study among Brothel-Based FSWs of City, Pune, India

Female sex workers (FSWs) report of suffering from symptoms of sexually transmitted infections (STIs), the most common are: lower abdominal pains (LAP), white discharge, genital ulcers and warts. It is important to study the proportion of FSW-reported symptoms of STIs to understand non-use of condoms with clients, their treatment seeking pattern to plan appropriate interventions to control STIs among FSWs. Mixed methods were used. A total of 80 FSWs were selected by two-stage cluster sampling method, followed by selection of 20 FSWs by convenient sampling for in-depth interviews. 55% FSWs reported of suffering from symptoms of STIs in last 6 months. FSWs preferred visiting private doctor for seeking treatment for symptoms of STIs; they had different misconceptions regarding transmission of STIs.

Abstract 369: Symptom Type and Characteristics Differentiate Early from Late Treatment Seekers for Symptoms of Atrial Fibrillation

Background: Delay in seeking treatment for symptoms of atrial fibrillation (AF) represents a missed opportunity for early treatment that is critical for reducing serious complications of AF such as stroke and heart failure. Delays ranging from a few days to years after symptom onset have been reported. Little is known about the symptom experiences and cognitive behavioral responses that differentiate those who seek treatment early after symptom onset from those who delay treatment-seeking. Purpose: This study compared symptoms and cognitive behavioral responses of early and late (up to 24 hours versus greater than 24 hours after symptom onset) treatment seekers with symptoms of AF. Methods: A descriptive design was used. Participants (N = 150) were recruited from a Midwest academic medical center. Data regarding 1) type and character of symptoms 2) cognitive and behavioral responses to the symptoms and 3) time from symptom onset to seeking treatment were collected using a structured interview. Independent t-tests for continuous variables and Chi-square tests for categorical variables were used to compare treatment seeking groups. Results: Participants were 51% female, with a mean age of 66.5 SD = 11.1) years. Early treatment seekers (n = 27) were more likely to experience a rapid heartbeat (p <.01), unremitting symptoms (<.001), report fear associated with symptoms (p = .005), and appraise symptoms as very serious (p <.001). They were less likely to believe symptoms could be self-managed (p <.001). Late treatment seekers (n = 123) were more likely to experience fatigue and dyspnea as primary symptoms (p≤ .01), report intermittent symptoms (p <.001), attribute symptoms to stress (p ≤ .02), deconditioning (p <.001), or lack of sleep (p = .009), and take a “wait and see” approach to managing symptoms (p <.001). There were no differences between early and late treatment seekers for age, sex, marital status, education level, and history of coronary artery disease or heart failure. Conclusions: Symptom type and characteristic, and cognitive behavioral responses of early treatment seekers differed from those of late treatment seekers. Experiencing a rapid heartbeat and unremitting symptoms may have helped participants form a cognitive appraisal and behavioral response conducive to early treatment-seeking. Experiencing intermittent symptoms less identifiable with a cardiac origin may have hindered development of cognitive appraisals and behavioral responses that promote early treatment- seeking. Education to promote early treatment-seeking for symptoms should include information about the diverse type and characteristics of symptoms of AF.

Abstract 4067: Responses to Symptoms among Older Patients with Acute Myocardial Infarction in Korea

Background: Older patients’ delay in seeking treatment for symptoms is longer than younger patients with acute myocardial infarction (AMI), and results in increased higher rates of mortality and medical expenses. Objectives: To identify their personal and cognitive responses to symptoms and related actions among older patients aged over 65 years with the first attack of AMI in Korea. Methods: Study sample included 89 older patients hospitalized at a University Hospital, a principal site of Korea Acute Myocardial Infarction Registry. Semi-structured interviews were conducted, after approval of institutional review board, on the 2 nd to 5 th day of their stay in the hospital following coronary intervention, lasted 30 – 40 min and tape-recorded. Results: Median delay time from symptom onset to hospital was 24 ± 136.6 hours and mean age was 73 ± 5.7 years. About 70% had an elementary school education or lower and chronic illnesses such as hypertension or diabetes. The 30% presented to hospital for their atypical symptoms rather than chest pain. Average length of hospital stay was 13 ± 8.3 days. Lower education, intermittent or progressive development of symptoms, and no attribution as cardiac problems increased patient delay. Many patients showed great patience with self-management to alleviate their discomfort in various ways, such as self-medication, letting blood from their finger, and laying down at home. Four describing themes for the delay behaviors emerged from the qualitative data that they had never imagined that they could have a heart attack because they were not sick even if they had hypertension or diabetes, attributed their symptoms to their chronic illnesses or natural complaints of older age, already attempted a medical help for their non-typical symptoms like a flu, and did not want to burden their families or medical expenses with their problems. Conclusions: The findings demonstrated unique coping responses to symptoms in Korean elders. Educational intervention for the elders at high risk group for AMI is needed to increase knowledge of AMI and facilitate their decision to seek immediate help following chest discomfort.

“Nothing is Wrong, Doctor”: Understanding and Managing Denial in Patients with Cancer

From a psychological perspective, denial is the process by which the mind defends itself against painful or threatening thoughts, feelings, perceptions, or information and may manifest in healthy or sick persons as well as in patients or those who care for them. For someone with a possible cancer diagnosis, there are several individual steps involved in the denial process, as the threatened meaning of one or more symptoms is sculpted into a more acceptable reality. Although most often felt to be a dysfunctional response, denial of illness is widespread and may serve an important adaptive or coping function, especially in a person facing the challenge of cancer. It may help a person cope with the various stages of their illness and treatment by allowing them time to process distressing information at a manageable rate. However, denial may also be dysfunctional, especially if it causes delay in seeking treatment for symptoms that present in the context of a true malignancy. Many clinicians misdiagnose denial when avoidance, disavowal, or another coping mechanism is invoked or when cognitive impairment or sensory deficits adversely affect perception. This article discusses denial in the context of cancer diagnosis, treatment, and prognosis and strategies for managing this common condition.

COGNITION AND THE BODY: SOMATIC ATTRIBUTIONS IN IRRITABLE BOWEL SYNDROME

How do somatic causal attributions for symptoms relate to treatment seeking behaviour in Irritable Bowel Syndrome (IBS)? How might a tendency to make somatic attributions influence an individual's cognitive representation of their illness once a diagnosis of IBS is established? In Study 1 attributions about symptoms were investigated in treatment-seekers and non treatment-seekers with IBS. Treatment-seekers had an increased tendency to make somatic attributions for both gastrointestinal symptoms and physiological symptoms characteristic of anxiety and depression, although they did not differ from non treatment-seekers in the severity of these symptoms or in their reports of psychological distress. Treatment-seekers also perceived themselves to be significantly less resistant to illness and to be significantly more likely to have poor health in the future than non treatment-seekers. In Study 2, 20 treatment seekers with chronic symptoms of IBS completed measures of mood and of the degree to which they viewed a range of symptoms as a part of their IBS. Physiological symptoms of anxiety and depression were seen as a part of IBS by a considerable proportion of the sample. Higher levels of depression were associated with an increased tendency to see physiological symptoms of anxiety and depression and even symptoms of colds as “a part of” IBS. It is concluded that a somatic attributional style may contribute both to initial treatment seeking for symptoms of IBS and the subsequent maintenance and exacerbation of the disorder once a diagnosis is established.

Delays in seeking treatment for symptoms: A new or overlooked dilemma in the care of heart failure patients

Delays in seeking treatment for symptoms: A new or overlooked dilemma in the care of heart failure patients

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.