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Lay Referral Patterns Involved in Cardiac Treatment Decision Making Among Middle-Aged and Older Adults

Correspondence: Address correspondence to Nancy E. Schoenberg, PhD, Department of Behavioral Science, 125 College of Medicine Office Building, University of Kentucky, Lexington, KY 40536-0086. E-mail: nesch{at}uky.edu

Purpose: This study examined age and contextually related factors that are influential in lay referral patterns during cardiac treatment decision making. Design and Methods: A complementary design was used. The Myocardial Infarction (MI) Onset Study identified demographic correlates of who sought medical care for 1,388 MI (heart attack) survivors. Thirty-five in-depth MI illness narratives explicated lay referral patterns. Results: Data revealed a linear association between older age and reliance on another person to seek medical attention for cardiac symptoms, with gender also shaping lay referral patterns. Although spouses and children were the most frequently cited decision makers for older respondents, friends and other family members also influenced care-seeking decisions. Qualitative results substantiated and provided explanations for such patterns. Implications: Our results highlight the need for researchers to attend to the complex social processes of lay consultation and for health education messages to extend to venues where lay cardiac decisions are made, including the worksite and social gathering places such as religious institutions. Enhanced outreach includes tailoring health messages to elders and their significant others and casting a broader net to include nontraditional significant others.

Key Words: Coronary heart disease • Treatment decision making • Lay referral • Gender

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