How well do you communicate with your doctor? Is he or she a good listener, or does your physician usually seem rushed and ready to jump to conclusions about what you are trying to convey? And have you ever felt you weren’t getting the care you needed because, well, your doctor saw you as a composite of the answers you filled out on a medical questionnaire?
These are the kinds of questions raised by the work of Melissa Clark, an associate professor of community health, who recently examined women’s experiences with screening tests for breast, cervical, or colorectal cancer as part of a five-year, three-phase study known as the Cancer Screening Project for Women. The project, funded with a $495,000 grant from the National Cancer Institute, is the first to contrast the experiences and attitudes of both married and unmarried women who receive their health-care in Rhode Island. Specifically, Clark wants to know what the experiences of the Rhode Island women might suggest about those of the more than 20 million U.S. women who are both unmarried and over forty. How, for example, do cancer screenings differ for gay women than for straight women?.
Clark held focus groups made up of 14 women who partner with women and 14 who partner with men. When she asked these divorced, widowed, legally separated, and never married women between the ages of forty and seventy-five to describe their experiences with cancer screenings, what she found is that, for many unmarried women, checking off the “single” box on screening questionnaires tended to lead to less-satisfying health-care experiences. In her report on the first phase of her project, published last April in Women & Health, Clark revealed that the experience can be so exasperating that many unmarried women avoid regular screenings for breast, cervical, and colorectal cancer altogether.
Unmarried women want their doctors and nurses to know about the nature of their sexual relationships, but most intake forms don’t allow the opportunity to explain anything more than whether or not they are married. Women also experienced a lack of privacy around their sexual preferences, a problem that is especially acute for older gay women, who grew up in a less accepting era. “When they have to go to three different places for three different exams,” Clark says, “they have to out themselves three different times: at the gynecologist’s, the mammographer’s and when they go to get a colonoscopy.”
These treatment differences may seem subtle, but they increase the unease of the patient, especially when they build over time. “Some of these women,” Clark says, “are offended by well-meaning doctors, nurses, and technicians who call them ‘Mrs.’ when they’re not, or who see a wedding band on a woman’s finger and assume she’s married to a man.” Single women of all kinds, she added, complained of asking to bring an unmarried partner to a test and being told that the rules allow only family to be present.
Clark hopes to broaden her look into how women’s treatment differs according to marital status or sexual preference. She used the general information gleaned from phase one of the screening project to guide her in writing mock intake forms that she then tested on another group of women in phase two of the project. She wanted to know whether the new questions seem more sensible, and whether they are more relevant and valid in asking for clinical information.
Clark’s project is now in its final phase. Researchers are randomly assigning 600 unmarried straight and gay women to three different groups, in which the women will be asked to answer yet another set of modified questions, this time by phone, computer, and on paper. The purpose of this phase is to test which of the three modes of communication work best in asking these kinds of questions. What will the project ultimately reveal? “I try not to pledge more than I think is realistic,” Clark says, “but I think we really do have an opportunity to inform state health policy.”