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  • 1
    Library Location Call Number Volume/Issue/Year Availability
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  • 2
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    New York, N.Y. : Periodicals Archive Online (PAO)
    Journal of community health. 16:1 (1991:Feb.) 37 
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  • 3
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    Silver Spring, Md., etc. : Periodicals Archive Online (PAO)
    Health and Social Work. 14:3 (1989:Aug.) 184 
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Breast cancer research and treatment 40 (1996), S. 65-74 
    ISSN: 1573-7217
    Keywords: breast cancer ; treatment ; age ; race ; socioeconomic factors ; hospitals ; physician practice patterns
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Guidelines for the optimal treatment of breast cancer have been publicized over the past 15 years, yet clinical practices continue to vary substantially in the United States. This article reviews the literature on variations in local and systemic treatment of breast cancer by patient and provider characteristics. Studies of local therapy have consistently demonstrated that older women are less likely than younger women to receive radiation therapy after breast-conserving surgery. Some studies have noted that black women are less likely than white women to receive breast-conserving surgery and less likely to receive radiation therapy after breast-conserving surgery. Rates of breast-conserving surgery vary three-fold among geographic regions and between teaching and non-teaching hospitals. Patients at smaller hospitals appear less likely to receive indicated radiation therapy. Patterns of systemic therapy have not been well described. Women over age 75 may not be receiving adequate hormonal therapy, but recent data are not available. Limited data suggest that rates of systemic therapy do not vary substantially by race or Hispanic ethnicity, but women without health insurance may not be receiving appropriate chemotherapy. Studies relating hospital and physician characteristics to the use of systemic therapy are sparse and inconclusive. In order to increase the proportion of women who receive optimal treatment for breast cancer and ensure greater equity, a more sophisticated understanding of variations in clinical practice will be required. These variations may arise from insufficient knowledge of or disagreement with guidelines among physicians, inadequate communication between physicians and patients, and individual preferences or clinical attributes of patients. Future studies will need to explore the dialogue between women and their physicians that leads to decisions about treatment of breast cancer.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1573-7217
    Keywords: breast cancer ; breast conserving surgery ; hospital practices ; mastectomy ; physician behavior
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We studied whether a hospital intervention utilizing medical opinion leaders and performance feedback reduced the proportion of women who reported that surgeons did not discuss options prior to surgery for early stage breast cancer. Opinion leaders provided clinical education to their peers using a variety of strategies and were selected for their ability to influence their peers. Performance feedback involved distributing performance reports that contained data on the outcomes of interest as well as on other treatment patterns. Twenty-eight hospitals in Minnesota were randomized to the intervention or to a control group that received performance feedback only. The proportion of patients at intervention hospitals who said that their surgeon did not discuss options decreased significantly (p〈0.001) from 33% to 17%, but a similar decrease was observed among control hospitals. Using medical opinion leaders to intervene in hospitals appeared as effective as performance feedback.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Journal of community health 16 (1991), S. 37-47 
    ISSN: 1573-3610
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The proportion of patients who receive intensive medical treatment outside the hospital environment has increased steadily over the past two decades. Active cancer chemotherapy outpatients (N=413) receiving treatment in the community were surveyed to document the prevalence and to identify the correlates of their daily living needs. Overall, 90% of the sample required help with some type of Personal, Instrumental or Administrative activity. Patients reported need for assistance with heavy housekeeping, shopping and completion of forms and paperwork most often. More than one-quarter (26.7%) of those requiring help reported that their need was unmet. Males, patients reporting poor physical functioning, and patients with children at home reported a greater level of need. Unmet need varied as a function of level of confidence in the ability of others to provide help, the number of helpers available as well as level of physical functioning and age. The relation between these results and potential intervention strategies to assist patients in meeting their needs is discussed.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1573-3610
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Failure to recognize symptoms which signal cancer may delay contact with the medical care system, thus decreasing the chances of diagnosis at an early stage of disease. We investigated the determinants of cancer symptom recognition and delay in seeking medical care in a population-based sample of 625 newly diagnosed lung, breast and colorectal cancer patients. Although the majority (79.5%) of patients reported noticing symptoms prior to diagnosis, one quarter of these patients (24.7%) delayed longer than three months in seeking medical care. Contrary to the findings of research based on clinic samples, logistic regression analysis revealed that no demographic or social support factors were predictive of symptom recognition or delay, with the exception that older colorectal cancer patients were less likely to notice symptoms, but also less likely to delay. Lung and colorectal patients diagnosed with advanced disease were more likely to notice symptoms than patients with local disease. Results of a content analysis of patients' remarks indicate that breast cancer patients were significantly more likely than lung or colorectal cancer patients to attribute their symptoms to cancer (p〈.001). Symptoms common to lung and colorectal cancer appear to be attributed to other, less serious causes. Given the lack of demographic predictors of symptom recognition and delay in seeking care, we suggest that education programs address risk groups for specific cancers, rather than the general public as a whole, grouping together all cancers and cancer symptomatology.
    Type of Medium: Electronic Resource
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