HEALTH CARE SYSTEM DEPENDENCY AMONG OLDER ADULTS: PATTERNS OF HOSPITAL USE BY LUNG CANCER PATIENTS.
Contributors: University of Washington.
Published: 1987
Number of pages: 253
Subjects: Health Sciences, Nursing.
Description: This study was designed to describe health care system dependency patterns among newly diagnosed lung cancer patients. Patient background and premorbid psychosocial characteristics, biomedical and psychosocial experiences in the first 2 months after diagnosis, and imminent death were examined for their effects on levels of hospital use between 2 and 6 months after diagnosis. Users and nonusers of hospitals were compared further on illness experiences between 2 and 6 months after diagnosis.

Longitudinal patient data (n = 78), collected as part of a larger Evaluation of Cancer Management Study by home interviews and medical record reviews, were used in addition to public domain provider data. Data analysis included multivariate statistical approaches.

The findings from multiple regression analyses indicated that biomedical experiences including early Treatment Effort and Primary Physician Specialty, and premorbid Personality Adjustment were important early predictors of later hospital use. Early Treatment Effort was the most consistent predictor of later hospital use for all reasons (Beta =.70, $p\le$.001) and for symptoms and complications of the cancer (SC) (Beta =.29, $p\le$.05). Gender (being male) positively predicted early Treatment Effort (Beta =.39, $p\le$.001), controlling for other factors. Analyses of longitudinal trends indicated that both Users and Nonusers of hospitals showed lowered levels of Treatment Effort after 10 weeks but different levels of Risk and divergent patterns of psychosocial Illness Disruption during that time.

The findings contribute to the literature on patterns of individual response to a life threatening illness when cure is unlikely. That the rigor of early curative and palliative treatment influenced a patient's later dependency on hospitals due to symptoms and complications indicates the importance of patients' early interaction with health care providers on later illness experiences. Moreover, that males received more rigorous early treatment suggests the importance of gender in the study of complex illness responses. That subjects having similarly advanced stages of disease at diagnosis showed different patterns of Illness Disruption over time indicates the diversity of patient psychosocial experiences within a diagnostic group. Differences were explained by an interaction between hospital use and time since diagnosis, and may have been present as early as 4 months after diagnosis.
Notes: Source: Dissertation Abstracts International, Volume: 49-02, Section: B, page: 0363.

Thesis (PH.D.)--UNIVERSITY OF WASHINGTON, 1987.

School code: 0250.