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Biomedical subjects

K M Cummings

Publications and source records attributed to K M Cummings.

At least 145 records · Page 8Linked to original sources
PubMed1983

The role of perceived price in physicians' demand for diagnostic tests.

This research examines the extent of physicians implicit price knowledge and its role in the physicians' demand for diagnostic tests. In particular, it examines the effect of perceived price on the quantity of test ordered. A group of 36 second and third-year residents and 23 clinical faculty members in three family practice centers affiliated with the Family Medicine Department of Wayne State University were randomly assigned to either a control group or an experimental group. They were asked to review four case studies and indicate on a test order form the tests they would order. The experimental group used a test order form that included the actual test prices and the control group used the same form but without the prices included. Subsequent to this, the control group (those without actual price information) was asked to estimate the price of all tests listed. Physicians' implicit price knowledge was measured by the number of underestimates, overestimates, and correct estimates and correlated with the total number of tests ordered. The results show the following tendencies: 1) physicians generally incorrectly estimate prices; 2) they tend to underestimate rather than overestimate; 3) they tend to underestimate the higher priced tests and overestimate the lower priced tests; 4) the greater the propensity to underestimate, the greater the number of tests ordered; 5) the greater the propensity to overestimate, the fewer the number of tests ordered; and 6) the greater the propensity to correctly estimate, the fewer the number of tests ordered. The results indicate that in the absence of actual prices, perceived prices enter the physicians' demand function and that physicians' demand for diagnostic tests might be categorized as rational.

Clinical Laboratory Techniques↗
PubMed1983

Delay, stage of disease, and survival among White and Black women with breast cancer.

Delay in obtaining treatment, stage of disease at diagnosis, and five-year survival were compared for 29 Black and 156 White females treated for breast cancer at Roswell Park Memorial Institute between 1957 and 1965. No statistically significant differences were found between Black and White patients in treatment delay although a tendency for longer delay among Blacks was noted. Race had little effect on survival when delay, stage of disease, and age were controlled.

Black or African American↗
PubMed1983

Family physicians' beliefs about breast cancer screening by mammography.

A survey of 509 family physicians in New York State was conducted to assess opinions about mammography and use of mammography in screening asymptomatic women of different ages. Findings indicate that most family physicians believe that mammography is an effective procedure for detecting breast cancer in its early stages, but many do not utilize mammography as a screening procedure in their own practices. The major deterrents to the use of mammography in screening asymptomatic women relate to concerns about the safety and reliability of the procedure, the low probability of detecting breast cancer through screening, the patient's willingness to accept a recommendation to have a mammogram, and cost. The results from this study point out the need to better educate primary care physicians about the use of mammography in screening for breast cancer, especially in regard to its safety and reliability.

Adult↗
PubMed1983

The effects of behavioral and biological factors on survival from breast cancer.

This research examined the relationship of symptom duration prior to treatment and tumor growth rate (as indicated by changes in symptoms before treatment) upon stage of disease, tumor size, and length of survival in a group of 160 females with an initial diagnosis of breast cancer. Cases were obtained from a 15% random sample of female breast cancer cases admitted to Roswell Park Memorial Institute between 1957 and 1964. Results showed that the association between duration of symptoms and survival varied depending upon the rate of tumor growth. Among patients characterized as having slower-growing tumors, duration of symptoms was inversely associated with length of survival. Among patients characterized as having faster-growing tumors, symptom duration had little influence on survival. These findings suggest that breast cancer control activities which decrease the interval from recognition of symptoms to diagnosis and treatment can favorably influence survival for patients with slower-growing tumors. For patients with faster-growing tumors, early diagnosis and treatment during the symptomatic period is not likely to substantially alter their chances for prolonged survival. For these patients, detection of asymptomatic cancer may be the best hope for improving their prognosis.

Adult↗
PubMed1982

The effects of price information on physicians' test-ordering behavior. Ordering of diagnostic tests.

This research evaluated the effects of providing physicians with information about the prices of diagnostic tests on their subsequent test-ordering behavior. The study population consisted of 36 second- and third-year residents and 23 clinical faculty in three family practice centers affiliated with the Department of Family Medicine at Wayne State University School of Medicine, Detroit, Michigan. Study participants were asked to review four case studies, each describing ambiguous symptoms, and to indicate on an attached test order form the tests they would order for each patient. Subjects were randomly assigned either to a group that received test order forms on which to prices of diagnostic tests were printed (price-information group) or to a group that received test order forms with no prices indicated (control group). The study results show that for each of the four cases, the average number of diagnostic tests ordered was significantly lower in the price-information group than in the control group. Our findings also show an average reduction in the cumulative cost of tests ordered per patient of 31.1 per cent related to the provision of price information is discussed and reviewed in light of other approaches that have been developed to modify physician behavior in ordering diagnostic tests.

Behavior↗
PubMed1982

Psychosocial factors affecting adherence to medical regiments in a group of hemodialysis patients.

The present research was designed to identify psychosocial correlates of adherence among patients receiving hemodialysis at two outpatient clinics. The 116 participants were interviewed concerning their knowledge of treatment, health beliefs, treatment history, social support, personal characteristics, and adherence to the medication, diet and fluid-intake aspects of the regimen. In addition, medical record data were obtained on serum phosphorus and serum potassium levels, and on between-dialysis weight gains. The magnitude of relationships between predictors and adherence measures varied, depending on the method used to measure adherence. For the self-report measures, beliefs concerning the efficacy of the behavior and barriers to the behavior, along with reported family problems, proved to be consistent predictors. Other beliefs and characteristics did not contribute significantly. For the medical chart information, however, the predictive factors were less consistent. In general, situational factors seem to be the major contributors to patient adherence, and adherence itself is seen as a complex and multidimensional phenomenon.

Adult↗
PubMed1982

Communication and behavior change for cancer control.

Even though behavior can sometimes be changed in a planned way without clear understanding or its original causes, efforts to modify behavior will ultimately be more successful if they grow out of an understanding of causal processes. The literature and experience in communication of health information have identified a number of conditions which affect the likelihood of health education campaigns being effective. Conditions conductive to effective attitude and behavior change through communications are summarized below: (1) Novelty in the way the message is presented to attract attention. (2) Use of multiple channels of communication to increase the probability of reaching the target audience. (3) Pretesting of health messages to ensure that the information is understood by the target audience. (4) Repetition of the message by multiple sources of high credibility. (5) Targeting of specific behaviors to be changed rather than a general orientation. (6) Incorporation of specific behavioral instructions (e.g. tips on how to quit smoking), in the communications. In conclusion, we have attempted to suggest that measured against what prudence science leads us to expect, cancer information and education programs have been dramatically effective. The challenge before us is to evaluate, refine and expand these efforts to reduce cancer incidence and mortality.

Behavior↗
PubMed1981

Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients.

This research examined the relative efficacies of three intervention strategies designed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients. The interventions examined included behavioral contracting (with or without the involvement of a family member or friend) and weekly telephone contacts with patients. Compliance was assessed with regard to following dietary restrictions and limiting fluid intake. Data were collected from 116 patients drawn from two outpatient clinics. Within clinics, patients were randomly assigned either to an intervention program or to a control group. The study employed a pretest-posttest control group design. Patients were interviewed before the intervention programs began (T1), after a 6-week intervention period (T2), and 3 months after completion of the intervention period (T3). Results showed that the interventions achieved substantial reductions in patients' serum potassium levels and in weight gains between dialysis treatments between T1 and T2. In general, however, these program effects tapered off to preintervention levels between T2 and T3. The findings thus indicate a need for long-term intervention programs.

Attitude to Health↗
PubMed1981

The structure and reliability of health belief indices.

A wealth of research using the Health Belief Model provides empirical evidence of the model's utility in predicting health, illness, and sick role behaviors. Until recently, however, little attention has been paid to the important issues of the validity and reliability of measures used to assess various health belief dimensions. Using factor analysis, our study demonstrates that moderately reliable indices covering a wide spectrum of distinct health beliefs can be constructed and then replicated across independent samples. The factor analysis approach revealed that condition-specific measures of perception of susceptibility and severity and situation-specific measures of perceived barriers are empirically distinct from general measures of these beliefs. We therefore recommend caution in mixing general and specific questionnaire items within the same index when measuring these beliefs. A factor representing perceptions of health threat emerged, but its composition require further clarification. The degree of similarity between the factor structures in the two independent samples provides support for the existence of independent health belief dimensions.

Attitude to Health↗
PubMed1980

Bringing the models together: an empirical approach to combining variables used to explain health actions.

Considerable confusion has existed among researchers with regard to the selection of a particular model of health behavior for study, and many investigators have long felt that the actual number of truly distinct concepts relevant to explaining health-related actions is considerably lower than the large number of variables currently employed. This paper explores selected approaches and models which have been advanced to explain health actions, in terms of structural similarities and differences identified by a panel of judges who are the relevant experts in this field. Judges were asked to partition a set of 109 variables, representing 14 different models, into 12-14 groups on the basis of similarity. The structural similarities among the variable groups were evaluated using Smallest Space Analysis. Six interpretable factors emerged from the analyses: (1) accessibility to health care, (2) evaluation of health care, (3) perception of symptoms and threat of disease, (4) social network characteristics, (5) knowledge about disease, and (6) demographic characteristics. The results of the study provide a first step in developing a unified framework for explaining health actions.

Attitude to Health↗
PubMed1979

Psychosocial determinants of immunization behavior in a swine influenza campaign.

A prospective design was used to study factors which predisposed individuals to receive vaccination in response to the anticipated outbreak of swine influenza in the fall and winter of 1976. Data were obtained from a telephone survey of 286 adults in Oakland County, Michigan. Predictor variables included Health Belief Model (HBM) variables as well as measures of behavioral intention, social influence, physician's advice, socioeconomic status and past experience with flu shots. In multivariate analysis, over 40 per cent of the variance in inoculation behavior was explained by the predictors used. Path analysis revealed that most of the HBM variables' influence on behavior was mediated through behavioral intention. While behavioral intention was an important predictor of inoculation behavior, other psychosocial factors played a significant role in explaining variance in the dependent variable.

Analysis of Variance↗