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The cognitive structuring of patient delay in breast cancer

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  • Facione, Noreen C.
  • Facione, Peter A.

Abstract

The reasons women give for delaying diagnosis of breast cancer symptoms are numerous and striking. Yet none prove reliable as indicators of those who will delay, and most women overcome all barriers to seek immediate diagnosis. This study looks more deeply into the reasoning of symptomatic women sustaining confidence in a decision to delay diagnosis of self-discovered breast symptoms. Using argument and heuristic analysis, we examined the structure and soundness of the reasoning in interviews with 28 women from the San Francisco Bay area monitoring breast symptoms. Fifteen women were sustaining decisions to delay seeking diagnosis. Their arguments' structure and soundness, and their dependence on heuristic strategies, were compared with those of women who did not delay. Prompt diagnosis-seekers used vivid stories of other women with breast cancer to explain their diagnosis seeking, and the others used similar stories to justify on-going decisions to delay. Diagnosis-seekers offered more arguments for doing so than for delay. Delayers offered fewer arguments for seeking diagnosis and many more for delay. Delayers abandoned sound and usually compelling arguments to seek diagnosis, relying instead on false information, poorly reasoned arguments, and self-created dominance structures around decisions to delay. Decisions to delay were resilient, yet required maintenance to sustain. Intervention studies aimed at decreasing patient delay should address the thinking process by questioning reliance on mistaken claims of control over possibly advancing cancer, satisficing (corner-cutting to arrive at a minimally adequate solution to achieve a goal) when scheduling diagnostic visits, simulating a benign diagnosis rather than the prevention of late-staged cancer, prioritizing fear control over protection of life. Interventions might also include challenging mistaken analogies and the too facile abandonment of sound arguments for seeking prompt diagnosis.

Suggested Citation

  • Facione, Noreen C. & Facione, Peter A., 2006. "The cognitive structuring of patient delay in breast cancer," Social Science & Medicine, Elsevier, vol. 63(12), pages 3137-3149, December.
  • Handle: RePEc:eee:socmed:v:63:y:2006:i:12:p:3137-3149
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    References listed on IDEAS

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    1. Facione, Noreen C., 1993. "Delay versus help seeking for breast cancer symptoms: A critical review of the literature on patient and provider delay," Social Science & Medicine, Elsevier, vol. 36(12), pages 1521-1534, June.
    2. Daniel Kahneman & Jack L. Knetsch & Richard H. Thaler, 1991. "Anomalies: The Endowment Effect, Loss Aversion, and Status Quo Bias," Journal of Economic Perspectives, American Economic Association, vol. 5(1), pages 193-206, Winter.
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    1. Catherine Cook & Margaret Brunton & Tepora Pukepuke & Ai Ling Tan, 2018. "Exploring communication during the journey from noticing bodily changes to a diagnosis of endometrial cancer," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(5-6), pages 1262-1275, March.
    2. J. S. Blumenthal-Barby & Heather Krieger, 2015. "Cognitive Biases and Heuristics in Medical Decision Making," Medical Decision Making, , vol. 35(4), pages 539-557, May.
    3. Aboud, Frances E. & Singla, Daisy R., 2012. "Challenges to changing health behaviours in developing countries: A critical overview," Social Science & Medicine, Elsevier, vol. 75(4), pages 589-594.
    4. Unger-Saldaña, Karla & Infante-Castañeda, Claudia B., 2011. "Breast cancer delay: A grounded model of help-seeking behaviour," Social Science & Medicine, Elsevier, vol. 72(7), pages 1096-1104, April.
    5. Andersen, Rikke Sand & Paarup, Bjarke & Vedsted, Peter & Bro, Flemming & Soendergaard, Jens, 2010. "'Containment' as an analytical framework for understanding patient delay: A qualitative study of cancer patients' symptom interpretation processes," Social Science & Medicine, Elsevier, vol. 71(2), pages 378-385, July.
    6. Savvakis Manos & Tzanakis Manolis & Alexias Giorgos, 2015. "Breast Cancer in Contemporary Greece: Economic Dimensions and Socio-Psychological Effects," International Journal of Finance, Insurance and Risk Management, International Journal of Finance, Insurance and Risk Management, vol. 5(3), pages 933-933.

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