Delivering messages correctly can be tricky, because they can cause unnecessary alarm, she said. “We need to be very careful about the types of messages which we deliver,” she said. “They must be carefully framed so they don’t increase anxiety among people who have hypochondriasis—general health anxiety—and increase the number of people going to see healthcare professionals with symptoms that don’t need medical intervention. So they do have to be carefully crafted.”
Why Patients Delay Care
Kristien Van der Elst, a PhD student and registered nurse at KU Leuven in Belgium, said research at her center has found psycho social factors, such as a belief that an outcome is inevitable regardless of whether a patient seeks help, play nearly as big a role in determining how long patients delay seeking treatment as the clinical factors themselves, such as swollen joint counts.
In an exploratory study of the CareRA trial, designed to determine optimal care for patients with early RA, 112 patients completed questionnaires on such things as how they perceive their disease and their coping strategies.2
Factors linked to longer delay included a strong belief in an inevitable or innocent disease cause; passive reacting, or the feeling of being totally overwhelmed by a problem situation; a limited understanding of the condition; a low number of swollen joints; and poor expectations the treatment will be able to control the disease.
In their analysis, psychosocial factors, such as illness perceptions and coping strategies, accounted for about 18% of the variability of patient delay, while clinical factors accounted for about 15%, Ms. Van der Elst said. Two-thirds of the variability in delay could not be explained by any of the factors they examined, she said.
Two patients seen at her center illustrate how psychosocial factors can play a pivotal role in delay. One woman was a general practitioner and contacted the rheumatology department after noticing her hand joints had begun to swell. When erosions on her feet were found, the woman said her feet had been painful and swollen for six months but she thought it was because of new tennis shoes.
“The causal attributions that Sophie related to her first symptoms caused the delay of at least six months in seeking help,” Ms. Van der Elst said.
In the other example, a construction worker first saw RA symptoms in his feet eight years before, then finally contacted a doctor because he was losing weight. Over the years, his arthritis had caused severe joint destruction. The error here was that he “thought he could cope” with his joint problems and “seriously misinterpreted the consequences of the symptoms.”
