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SUMMARY
Based upon preliminary qualitative data from interviews with women who have experienced breast cancer, the potential for provider bias of preconceived impressions exists in the Appalachian region to act as a barrier to cancer screening. A Provider Bias Instrument for Assessing Cancer Screening (the “PBIAS”) was developed and validated as an appropriate proxy for the actual decision made by rural primary health care providers to order a cancer screening test. Key variables were defined as part of the Instrument. Scripted trigger tapes were tested with Appalachian primary care provider focus. Variables included perceptions of patients’: fatalism, present-day orientation, anxiety, patient-primary care provider relationship, and socioeconomic status. The portrayal of these variables was altered or dropped after validation focus groups with regional primary care providers.
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FINDINGS
16.1 Based upon preliminary qualitative data from interviews with women who have experienced breast cancer, the potential for provider bias of preconceived impressions exists in the Appalachian region to act as a barrier to cancer screening.
16.2 A Provider Bias Instrument for Assessing Cancer Screening (the “PBIAS”) was developed and validated as an appropriate proxy for the actual decision made by rural primary health care providers to order a cancer screening test.
16.3 There were changes in the definitions of the qualifying variables as each was validated with Appalachian health providers:
a. Fatalism: the patient’s belief that there is no cure for their medical condition. They think it’s not in their hands because this is their fate. Changed FROM the patient’s belief that there is no cure for cancer. And, they often think it’s in God’s hands, TO elimination of ‘cancer’ to avoid a correct-answer bias.
b. Present-day Orientation: as a way of being or an attitude where patients do not believe in planning for the future. DROPPED as it consistently overlapped with fatalism in the minds of the rural PCPs.
c. Patient Anxiety: ‘the levels of anxiety patients have towards their health. CHANGED: to ‘the levels of anxiety patients have towards their health‘.
d. Patient-PCP relationship: A strong relationship-patient shows trust, appreciation and effective communication. FROM: A poor relationship- patient shows distrust, aggressiveness and ineffective communication, TO: A strong relationship-patient shows trust, appreciation and effective communication and a poor relationship- patient shows distrust, aggressiveness and ineffective communication.
e. Socioeconomic status: social class of the patient. CHANGED: to cues for SES as demonstrated through education level, income level, occupation, dress and language.
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