Decision making in a health care crisis men under 60 diagnosed with prostate cancer
Sponsored Links
This presentation is the property of its rightful owner.
1 / 37

Decision-making in a health care crisis: Men under 60 diagnosed with prostate cancer PowerPoint PPT Presentation

  • Uploaded on
  • Presentation posted in: General

Decision-making in a health care crisis: Men under 60 diagnosed with prostate cancer. Tawna Skousen Supervisory Committee Members: Lynne Durrant, PhD Chair (HPE) Barbara J. Richards, PhD (HPE) Susan L. Morrow, PhD (Educ Psychology) Teresa M. Pavia, PhD (Marketing)

Download Presentation

Decision-making in a health care crisis: Men under 60 diagnosed with prostate cancer

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

Decision-making in a health care crisis: Men under 60 diagnosed with prostate cancer

Tawna Skousen

Supervisory Committee Members:

Lynne Durrant, PhD Chair (HPE)

Barbara J. Richards, PhD (HPE)

Susan L. Morrow, PhD (Educ Psychology)

Teresa M. Pavia, PhD (Marketing)

Saundra S. Buys, MD (Oncology)


  • Background & Introduction

  • Literature Review

  • Research Questions

    How I did it

  • Methods

    What I found out

  • Results

    What I thought about what I found out

  • Discussion

Background & Introduction

Prostate cancer is an “old man’s” diseaseAnnual age-specific incidence rates, 1973-2000

Literature Review

  • The Big “C”

    • Prostate cancer

Literature Review

  • The Big “D”

    • Decision making

  • When Big “C” meets Big “D”

    • Decision making &

      prostate cancer

Research questions

Research question #1

  • What are the decisions being made by men diagnosed with prostate cancer under age 60?

Research question #2

  • What are the data elements associated with these decisions? How do they reach a treatment decision? (Are there particular steps?)

    • Subsumed under this question: To what extent are health care decisions based on past experiences of decision-making? To what extent are they dependent on doctor recommendation or support systems and other feedback? To what extent are these treatment decisions based on fear of death – or fear of impotence or incontinence? Are their decisional processes the same as when making any other major decision?


Qualitative focus

  • Designed to explore human aspects and life’s circumstances

  • Seeks to understand what the situation/phenomenon/experience means

Grounded theory

  • Is used to generate a middle-range theory that explains basic social processes

    • Rationale: a theory formed during data collection will be more applicable than one developed before a study begins

  • Symbolic interactionism

    • meaning, language, thought

Grounded theory, cont.

Data CollectionData Analysis

First Interview

Preliminary Categories

Second Interview

Refined Categories

Third Interview

More Refined Categories

Close to Saturated




  • Recruitment

  • Sampling


Demographic questionnaire

Field observation

Archival materials


Data collection

Data analysis

  • Concept formation & development

    • Coding: open, axial, selective

    • Core category

  • Concept modification & integration


-Phone: said biopsy was “positive” for cancer – “so, come in soon, okay?”

-Phone: nurse said “you have a little bit of cancer”

Medical communication



-“Sheer panic”. Wanted cancer out ASAP.

-Not overwhelmed or shocked

Emotional impact


-Even-tempered, handles stuff well

Initial management

-Job, family responsibilities

Developmental stage

-”Biggest support is family”

Support system

Domain I: Health Care Orientation

  • Family experience

  • Health care experience

  • Health care beliefs

Domain II: Crisis of Diagnosis

  • Medical communication

  • Emotional impact

  • Initial management

    • Support

      [wife] “From the beginning, the cancer had become ‘ours,’ not just his. I became involved in his treatment decisions and went with him to his doctor’s visits, asking many questions. Later, I would find myself saying things like, ‘We’re going to have surgery.’”

Domain III: Investigating Prospects

  • Information acquisition

    “I wasn’t hearing anything I wanted to hear.”

    “I wanted good honesty, not bad honesty.”

    “…proceeded to get drunk and started searching the Internet - which was probably a huge mistake, but in some ways, it is good that I educated myself. Um.. I mean a lot of it just flat scared me to death and made me depressed beyond words.”

  • Issues explored

  • The emotions I was feeling were shock, depression; the worst pain of all was having my son, my little 7 year old son, see me whither away and not be the strong thing that he had come to know. And that was making me feel the worst. Um.. I want to be, I want him to be proud of me.”

Synthesizing data

Expert opinions

Domain IV: Determining Choice

Domain V: Reflections

  • Treatment experience

  • Precipitating event

  • Education and knowledge wished for

  • Lifestyle change

  • Meanings of and reasons for cancer

Core Category

  • Main theme, pulling all other categories together

  • Reflects actions/decisions of participants


Health Care


Crisis of Diagnosis

Determining Choice

Investigating Prospects

Time crunch



Treatment experience

Health Care


Crisis of Diagnosis

Investigating Prospects

Determining Choice

Time crunch




Symbolic Interactionism

  • Meaning

    • Fear, dread, belief of imminent death if cancer not removed

    • Unpleasant, unwelcome disease that could be treated and eliminated

  • Language

    • “Get it out!” “Cut it out!”

      • Surgery (excise cancer)

    • “Get rid of it.” “Deal with it.”

      • Pursued other options (eliminate cancer)

Symbolic Interactionism

  • Thought (mental conversation)

    • Hope versus harsh reality

      • HOPE: doctor assurances, others’ positive experiences, religion, philosophy, spiritual beliefs

      • HARSH REALITY: others’ negative experiences, recurrence


My domains (categories)

Health Care Orientation

Health Care Beliefs

Crisis of Diagnosis

Investigating Prospects

Determining Choice

Treatment Experience



Decision theory stages

Environmental, Internal Factors

Biases, Heuristics

Diagnostic, Identification of the Problem

Actions, Obtaining Necessary Information, Production of Possible Solutions or Alternatives

Evaluation of Solutions, Selection of Alternative or Strategy

Implementation of Selection

Evaluation of Selection, Probabilities for Recurrence, Regret Theory

Utilities, Rewards, Satisficing



  • Sample size

  • Demographics

    • Education, ethnicity, SES – insurance


  • Provides a research-based framework to explain decisions made in the context of a health crisis.

  • Provides insight to educators, health care providers, and researchers about influences involved in making treatment decisions

  • Facilitates decision making (understanding of components and personal values)

  • Login