BREAST SCREENING OUTCOMES COMMUNICATION PROBLEMS; CHAOS RELATIONSHIP AND CONTROL THEORY

B.S. THORNTON, H.T. NGUYEN, W.T. HUNG,
CHERRELL HIRST, ELYSIA THORNTON AND T.N. LANGTRY

Abstract. For a project to aid doctor-patient communication for practicing physicians and medical graduates, we have a model which shows the way that nonlinear dynamics and chaos theory can account for the type of reactions observed in women when the possibility of a positive indication is communicated to them in breast screening. In practice, the content and style of the doctor-patient communication of possible cancer and its subsequent implications is a sensitive matter. It can produce a range of patient attitudes often depending on her endogenous modification of the initial probability of the indication of cancer and the associated information given regarding subsequent biopsy and possible surgery and therapies. In some cases drop-out from a screening program may follow if the situation is handled poorly for women with excessive anxiety and stress reactions. Interventions may not prolong life but they can improve quality. The model can provide on-screen interactive demonstrations for medical practitioners to show the importance of appropriate communication of the necessary information in a manner consistent with the patient's concern and state of mind. It also allows a user to be made aware of limit cycles and bifurcations in a visual manner and how they relate to this problem in practice, hopefully stimulating new considerations for counseling intervention to help stabilize undesirable reactions. Based on recent research in control theory, the model suggests that the chance of success in stabilisation of responses is dependent upon the timing of interventions during the period of disturbance and may be different from sequences often used with patients.