Psychological predictors of attendance at annual breast screening examinations.

This retrospective analysis of psychological predictors of attendance studied the women from the annual screening arm of the United Kingdom Coordinating Committee on Cancer Research (UKCCCR) trial of annual screening mammography for the early detection of breast cancer. Some women attended screening at the first invitation in year 1 (attenders), others did not attend for screening at any time (non-attenders), whereas a third group delayed attending until year 2 (ambivalent attenders). A total of 147 women were recruited to the study: 80 attenders, 28 non-attenders and 39 ambivalent attenders. It proved extremely difficult to contact non-attenders to take part in the study. Non-attenders were significantly more depressed on the Hospital Anxiety and Depression Scale; had experienced more miscarriages, stillbirths or terminations of pregnancy; were less knowledgeable about mammography; and were displeased to have received an invitation to screening. Whereas non-attenders are unlikely ever to attend breast screening because of their long-standing attitudes and preferred coping styles, ambivalent attenders may become more amenable to screening with the passage of time. In this study such women were persuaded to attend in year 2 with a simple, cost-effective intervention: an additional invitation letter after a year.

Psychological aspects of cancer surgery: surgeons' attitudes and opinions.

Fifty-one surgical consultants, registrars and senior registrars in NHS hospitals in the West Midlands (UK) were interviewed about psychological aspects of cancer surgery: information given to patients, the bad news interview, psychological risk factors in surgery, psychiatric morbidity, difficult patients, and care of the dying. Information that tended to be provided infrequently included the cause of the disease, the effects of surgery on sexual functioning, and psychological side-effects of the surgery. Surgeons most often answered incompletely patients' questions about prognosis, effects of surgery on sexual functioning, the presence of malignancy, and probable length of life. Concerning the disclosure of malignancy, 37% said they always tell the patient; 8% tell virtually all patients; 49% tell the patient depending on the patient's and relatives' wishes; and 6% tell the relatives and possibly the patient. A common strategy among 49% is to use the word 'growth' and wait for the patient to ask further. Few surgeons took even the briefest psychiatric history, and only the most severe post-operative psychological complications were referred to psychiatrists. The most difficult patients for surgeons to manage were emotionally labile, angry, demanding, controlling, refusing treatment, or predicting failure. The surgeons in this sample clearly struggled with their role as giver of bad news and with the consequent emotional reactions of the patient.

Do counsellors in general practice surgeries and clinical psychologists in the National Health Service see the same patients?

An audit was conducted of a counsellor's work over the period 1989-1993 at two general practice surgeries in Coventry. Comparative data were available for general practitioner (GP)-referred patients seen in the district clinical psychology department in Coventry during 1988-1992. The counsellor saw significantly more patients referred with anxiety, depression, marital problems, child management and physical illness than did psychologists, whilst psychologists saw significantly more patients with relationship problems and personality disorders. To the question, 'Are these services effective?' the answer is yes, both services are effective, but they are treating different patient populations.