To date, research on barriers to care has largely focussed on influences affecting the utilization of services (economic, cultural, social psychological, organizational, and geographic): few studies have examined reasons for variability in care a at later stage in the process, after utilization has occurred (i.e., during the patient-provider encounter). The proposed study will fill knowledge gaps by; (a) identifying within the context of the patient-provider relationship, barriers to appropriate diagnosis and treatment of symptomatic breast cancer in women aged 65 years and over; and (b) evaluating a specific patient intervention designed to remove these identified barriers. Physicians' evaluations of patients' presenting symptoms are generally thought to be relatively free of extraneous influences and guided by biomedical criteria. However, prior research suggests that patient sociodemographics and personal characteristics of physicians influence physician preferences. Since physicians are gatekeepers to costly treatment and technology required to care for older people, it is important for effective case management and public policy to disentangle the factors influencing physician preference in diagnosis and treatment of older women with breast cancer.
