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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)

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decision making in a health care crisis men under 60 diagnosed with prostate cancer

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)

outline
Outline
  • 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
prostate cancer is an old man s disease annual age specific incidence rates 1973 2000
Prostate cancer is an “old man’s” diseaseAnnual age-specific incidence rates, 1973-2000
literature review
Literature Review
  • The Big “C”
    • Prostate cancer
literature review1
Literature Review
  • The Big “D”
    • Decision making
  • When Big “C” meets Big “D”
    • Decision making &

prostate cancer

research question 1
Research question #1
  • What are the decisions being made by men diagnosed with prostate cancer under age 60?
research question 2
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
Qualitative focus
  • Designed to explore human aspects and life’s circumstances
  • Seeks to understand what the situation/phenomenon/experience means
grounded theory
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
Grounded theory, cont.

Data CollectionData Analysis

First Interview

Preliminary Categories

Second Interview

Refined Categories

Third Interview

More Refined Categories

Close to Saturated

Categories

Saturation

participants
Participants
  • Recruitment
  • Sampling
data collection
Interviews

Demographic questionnaire

Field observation

Archival materials

Memos

Data collection
data analysis
Data analysis
  • Concept formation & development
    • Coding: open, axial, selective
    • Core category
  • Concept modification & integration
slide22

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

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

Medical communication

CRISIS of

DIAGNOSIS

-“Sheer panic”. Wanted cancer out ASAP.

-Not overwhelmed or shocked

Emotional impact

Personality

-Even-tempered, handles stuff well

Initial management

-Job, family responsibilities

Developmental stage

-”Biggest support is family”

Support system

domain i health care orientation
Domain I: Health Care Orientation
  • Family experience
  • Health care experience
  • Health care beliefs
domain ii crisis of diagnosis
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
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.”
domain v reflections
Domain V: Reflections
  • Treatment experience
  • Precipitating event
  • Education and knowledge wished for
  • Lifestyle change
  • Meanings of and reasons for cancer
core category
Core Category
  • Main theme, pulling all other categories together
  • Reflects actions/decisions of participants

Expectation

slide29

Health Care

Orientation

Crisis of Diagnosis

Determining Choice

Investigating Prospects

Time crunch

Reflections

Expectation

Treatment experience

slide30

Health Care

Orientation

Crisis of Diagnosis

Investigating Prospects

Determining Choice

Time crunch

Reflections

Expectation

symbolic interactionism
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 interactionism1
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

shortlong

decision making
My domains (categories)

Health Care Orientation

Health Care Beliefs

Crisis of Diagnosis

Investigating Prospects

Determining Choice

Treatment Experience

Reflections

Expectation

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

Decision-making
limitations
Limitations
  • Sample size
  • Demographics
    • Education, ethnicity, SES – insurance
implications
Implications
  • 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)