Facione Noreen C, Facione Peter A
University of California San Francisco, USA.
Soc Sci Med. 2006 Dec;63(12):3137-49. doi: 10.1016/j.socscimed.2006.08.014. Epub 2006 Sep 25.
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.
女性推迟乳腺癌症状诊断的原因众多且显著。然而，没有一个原因能可靠地指示哪些女性会推迟诊断，而且大多数女性会克服一切障碍去寻求即时诊断。本研究更深入地探究了有症状的女性在决定推迟自我发现的乳房症状诊断时仍保持信心的推理过程。通过论证和启发式分析，我们在对旧金山湾区28名监测乳房症状的女性进行访谈时，审视了她们推理的结构和合理性。15名女性坚持推迟寻求诊断的决定。我们将她们论点的结构和合理性，以及她们对启发式策略的依赖程度，与未推迟诊断的女性进行了比较。急于寻求诊断的女性用其他患乳腺癌女性的生动故事来解释她们寻求诊断的行为，而其他女性则用类似的故事为持续推迟诊断的决定辩护。急于寻求诊断的女性为这样做提供的论据比为推迟诊断提供的论据更多。推迟诊断的女性为寻求诊断提供的论据较少，而为推迟诊断提供的论据则多得多。推迟诊断的女性放弃了合理且通常很有说服力的寻求诊断的论据，转而依赖错误信息、推理不充分的论据以及围绕推迟诊断决定自行构建的主导结构。推迟诊断的决定具有弹性，但需要维持才能持续下去。旨在减少患者推迟诊断情况的干预研究应通过质疑对可能进展的癌症过度主张控制、安排诊断就诊时敷衍了事（走捷径以达成一个最低限度足够的解决方案来实现目标）、模拟良性诊断而非预防晚期癌症、将恐惧控制置于生命保护之上等思维过程来进行。干预措施还可能包括挑战错误的类比以及轻易放弃寻求及时诊断的合理论据。
