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PAPERS: Jill Pattenden, Ian Watt, Robert J P Lewin, and Neil Stanford Decision making processes in people with symptoms of acute myocardial infarction: qualitative study BMJ 2002; 324: 1006 [Abstract] [Full text]

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Decision-making processes are similar in first-time and repeat MI sufferers

Alexander M Clark   (29 April 2002)

A consideration of the Self-Regulatory Model of Illness Behaviour in reducing patient delay.

Jane C. Walsh   (1 May 2002)

Neglected Sources: The Limitations of Medline

Robert Dingwall   (14 May 2002)

Decision-making processes are similar in first-time and repeat MI sufferers 29 April 2002
Alexander M Clark, Research Fellow Univserity of Glasgow, Department of Medicine and Therapeutics, Tennent Institute, Glasgow, G12. Send response to journal: Re: Decision-making processes are similar in first-time and repeat MI sufferers	The findings of Pattenden et al 1 on decision-making during the early stages of myocardial infarction (MI) after a previous cardiac event are strikingly similar to previously published qualitative work that I have undertaken with first time MI sufferers 2. In both these studies, delays were fostered by the dynamic interplay between conceptions of the self, perceptions of symptoms (or, as I prefer, the body) and beliefs about CHD. Both groups also discussed symptoms with their significant others and sought General Practitioners advice before contacting emergency services. These studies remind us that it is generally not advisable for health professionals to play down the possibility of MI occurring to those at risk of events. This appears to reinforce individuals’ understandable though potentially tragic tendencies to continue to believe they are suffering from benign conditions. Though well intentioned, false reassurance is ethically dubious and may, paradoxically, increase anxiety 3. Interestingly, other groups that are consistently found to delay longer (women, diabetics and the elderly)also report having particularly ambiguous experiences of pain 4-7. Further research into experiences of the body during cardiac pain is required in these groups to determine the specific nature and origin of these ambiguities. 1. Pattenden J, Watt I, Lewin RJP, Standford N. Decision making process in people with symptoms of acute myocardial infarction: a qualitative study. British Medical Journal 2002;324:1006. 2. Clark AM. Treatment decision making during the early stages of heart attack: a case for the role of body and self. Sociology of Health and Illness 2001;23(4):425-446. 3. Stewart M. Effective physician-patient communication and health outcomes: a review. Canadian Medical Association Journal 1995(152):1423- 33. 4. Paterson BL, Sloan J. A phenomenological study of the decision-making experience of individuals with long standing diabetes. Canadian Journal of Diabetes Care 1994;18(4):10-19. 5. Dracup K, Moser DK. Beyond sociographics: Factors influencing the decision to seek treatment for symptoms of acute myocardial infarction. Heart and Lung 1997;26(4):253-262. 6. Bendelow GA, Williams SJ. Natural for women, abnormal for men: Beliefs about pain and gender. In: Nettleton S, Watson J, editors. The Body in Everyday Life. London: Routledge, 1998:199-217. 7. Hernandez CA, Bradish GI, Rodger NW, Rybansky SI. Self-awareness in diabetes: Using body cues, circumstances, and strategies. Diabetes Educator 1999;25(4):576-584.
A consideration of the Self-Regulatory Model of Illness Behaviour in reducing patient delay. 1 May 2002
Jane C. Walsh, Lecturer Psychology Dept. St Anthony's, National University of Ireland, Galway. Send response to journal: Re: A consideration of the Self-Regulatory Model of Illness Behaviour in reducing patient delay.	The results of Pattenden et al. 1 complement those found in recent research in the field of Health Psychology using the Self-Regulatory Model of Illness Behaviour (SRM) 2 as a framework for understanding patient delay in the event of an AMI. Several researchers have identified SRM as an appropriate framework within which to consider developing appropriate interventions to reduce delay times 3-6. The SRM proposes that health and illness behaviour are directed by two inter-related aspects regarding beliefs about a disease, and that people learn to think and feel about somatic and illnesses sensations from prior symptom episodes and on-going visceral experiences. The findings of Pattenden and colleagues support this assertion, acknowledging that the decision to seek help is a complex interaction of knowledge, experience, beliefs, emotions and contextual factors. In line with Pattenden et al.'s recommendations, I would support the development of interventions that take into account these findings, but suggest, in addition, a consideration of the components of the SRM in these developments. 1. Pattenden, J., Watt, I., Lewin, R.J.P., Standford, N. (2002). Decision making processes in people with symptoms of acute myocardial infarction: qualitative study. British Medical Journal, volume 324, pp.1006 - 1011. 2. Leventhal J, Meyer D, Nerenz D. The common-sense representation of illness danger. In: S Rachman, Medical Psychology (27-30). Pergamon, New York, NY. 3. Dracup K, Moser DK, Eisenberg M, Meischke H, Alonzo AA, Braslow A. Causes of delay in seeking treatment for heart attack symptoms. Soc. Sci. Med. 1995;40(3):379-392. 4. Dempsey SJ, Dracup K, Moser DK. Women's decision to seek care for symptoms of acute myocardial infarction. Heart & Lung Journal of Critical Care 1995 Vol. 24(6), Nov/Dec. pp. 444-456. 5. Raczynski JM, Finnegan JR, Zapka JG, Meischke H, Meschack A, Stone EJ, Bracht N, Sellers DE, Daya M, Robbins M, McAlister A, Simons-Morton D. (1999). REACT theory-based intervention to reduce treatment-seeking delay for acute myocardial infarction. American Journal of Preventive Medicine, 16(4): 325-334. 6. Leviton LC, Finnegan JR, Zapka JG, Meischke H, Estabrook B, Gilliland J, Linares A, Weitzman ER, Raczynski J. Stone E. Formative research methods to understand patient and proviser response to heart attack symptoms. Evaluation and Programme Planning 1999; 22L 385-397.
Neglected Sources: The Limitations of Medline 14 May 2002
Robert Dingwall, Professor and Director, IGBiS University of Nottingham, NG7 2RD Send response to journal: Re: Neglected Sources: The Limitations of Medline	Pattenden et al.'s paper is an interesting and useful contribution to understanding the complexity of the processes that intervene to transform changes in body state or perceptions into social action. However, it also illustrates the growing problem of shallow searches based on electronic tools. This particular problem was investigated in some depth using similar methods by Cowie in a University of Aberdeen PhD with a summary publication in 1976 (Cowie, B. The cardiac patient's perception of his heart attack. Social Science and Medicine 1976 10: 87-96). Cowie concentrated on people experiencing their first heart attack, which would have provided a particularly valuable contrast to the victims of second and subsequent attacks studied by Pattenden et al. It is important to recognize that the processes studied by social science and the findings reported on them are less bound to the contemporary moment than is the case in clinical or bioscientific areas. Strategies need to be found to dig deeper into the accumulated wisdom of a field than present electronic archives permit. The memories of the middle -aged among us are not a good substitute!