Factors Influencing Total Delay of Breast Cancer in Northeast of China

Objectives

Delay in diagnosis and treatment, called total delay, could probably result in lower survival rates in breast cancer patients. This study aimed to investigate the factors associated with the comprehensive delay behaviors and to evaluate its effect on outcomes in patients with breast cancer in Dalian, a northeast city of China.

Methods

A retrospective chart review was conducted using a cancer registry dataset including 298 patients. The Kaplan–Meier survival analysis was used to identify the threshold of total delay, dividing the patients into a group with significant uncertainty and a group without substantial delay. The factors associated with the significant total delay were investigated from the potential candidates, like income level and marital status, by using the chi-squared test. The difference of the clinicopathologic characteristics between the patients grouped by the significant total delay, like tumor size and lymph node metastasis, was also investigated to find out the effect of the total delay.

Results

A total of 238 charts were used for analysis. The mean age was 57.3. The median of total delays was 3.75 months. Thirty days was identified as a threshold, more than which the total delay can lead to worse survival. Patients’ marital status (p = 0.010), income levels (p = 0.003), smoking status (p = 0.031), initial visiting hospital level (p = 0.005), self-health care (p = 0.001), and self-concern about initial symptom (p ≈ 0.000) were identified as the independent predictors of the total delay. Metastasis (p ≈ 0.000) was identified as the significant result relating to the significant total delay.

Conclusions

A total delay of more than 30 days predicts worse survival in breast cancer patients in Dalian. Several factors, like patients’ marital status and income levels, can be considered to be relevant to the significant total delay. We recommend that these factors be used to predict the potential patients with the significant total delay in the clinical practice.

Enhancing social support and knowledge perception decreases patient delay in breast cancer

BACKGROUND

Patient delay commonly appears in breast cancer (BC), but the findings for influential factors may be contaminated by recall bias. The real factors in patient delay (divided into appraisal delay and utilization delay) for women with BC urgently need to be objectively analyzed for preventing the progression of this disease.

METHODS

Women meeting strict inclusion and exclusion criteria were asked to fill in a questionnaire, which included three sections of sociodemographic characteristics, medical history, and knowledge of BC. Later on, the outcomes were processed according to the verification of BC by pathological diagnosis. Then, multiple linear regression was conducted to analyze the potential factors of the delay and to explore their relations between these factors and BC.

RESULTS

Appraisal delay is the leading component of patient delay. Appraisal delay's time distribution of a higher percentage at delay time 0-29 and >360 days, while other delay time occupies lower percentage, which is highly consistent with that of patient delay, while utilization delay mainly occurs in the 0-29 days period. Concerning the influential factors for the different phases of delay, age (P=0.051, P=0.035 separately in appraisal and patient delay), residential address (P=0.036, P=0.010) and symptom disclosure to others (P=0.015, P=0.015) led to a decrease of appraisal and patient delay. However, reasons for first medical consultation (P=0.033, P=0.006) and knowledge of BC (P=0.027, P=0.002) would accelerate appraisal and patient delay. Many factors related to hospitals, such as hospital category for first medical consultation (P=0.030) and examinations for first medical consultation (P=0.055) would reduce utilization delay.

CONCLUSIONS

Obstacles in medical consultation for younger women should be removed, and early interventions are needed to avoid progression of BC.

Delayed help-seeking for symptomatic breast cancer: reasons for delay among participants receiving treatment at a public healthcare facility in South Africa

We explored delayed help-seeking behaviour for symptomatic breast cancer among a sample of female patients attending an outpatient breast cancer clinic at a tertiary public hospital in the Western Cape. The objective of the research was to explore the perceived personal and structural barriers to help-seeking among women with breast cancer from this low-resource setting, as this information has not been documented. Purposive sampling was used to recruit 25 breast cancer patients. Patients participated in individual interviews that were audio-recorded and transcribed. We conducted a thematic analysis using both inductive and deductive coding. Participants’ limited knowledge of breast cancer, negative views of the healthcare system, and challenging life experiences, such as marital discord, perceived lack of support, and caring for sick loved ones, contributed to their help-seeking delays. We used a combination of the Common-Sense Model of Self-Regulation and Bronfenbrenner’s Ecological Systems theory to conceptualize and organize these findings. A general lack of breast cancer knowledge was a major contributing factor to help-seeking delays among participants in the study. This finding was surprising considering that several breast cancer awareness campaigns have been run both nationally in South Africa and internationally. We call attention to the need for accessible breast cancer information at primary healthcare and community levels.

Presentation of breast cancer, help seeking behaviour and experience of patients in their cancer journey in Singapore: a qualitative study

BACKGROUND

Little is known about the presentation, help seeking behaviour for breast cancer in Singapore. Nor was there a study exploring the experience of patients in their breast cancer journey.

METHODS

A qualitative interview study with thematic analysis, conducted with 36 patients.

RESULTS

There is no clear pattern of presentation for breast cancer by cancer stage at diagnosis, age and ethnicity in the cancer journey of this group of patients. Patients were diagnosed with early to advanced stages cancer regardless of when they presented or took up treatment in their cancer journey. The reasons patients sought medical attention also did not appear to differ between the stages of cancer diagnosed, ethnic and age. Without setting a measure to define early and late presentation, we found that women shared similar experience in their breast cancer journey, regardless of age, ethnicity and stage of cancer at diagnosis. Poor knowledge of breast cancer (symptoms and causes); few practised regular BSE; denial of symptom; fear of hospitalisation, diagnosis and treatment; worries and stress over financial burden of treatment; misinformation in magazine and online sources; diet; stress; caring responsibility; support network; and use of alternative medicine before and after diagnosis were identified in patients' narratives. Strong social support; fear of being an emotional and financial burden for the family; and financial worries during treatment were also the recurring themes after diagnosis.

CONCLUSION

A measure of breast cancer presentation - that accounts for the patient's experience in the cancer journey, the time interval and tumour biology - that is meaningful to patients, clinicians and researchers is needed. For research on late and delayed presentation, details on BSE practice - how often, when and was it done correctly - will improve the accuracy of time delay interval. For the public, concerted efforts to improve knowledge of breast cancer, survival and prognosis for early-diagnosed cancer, and the importance of regular and correct technique to perform BSE, are critical and urgent to address the rising breast cancer incidence in the country.

Seeking healthcare at their 'right' time; the iterative decision process for women with breast cancer

Background

About 85% of breast cancer patients attending Komfo Anokye Teaching Hospital (KATH), Ghana, present with stage III/IV disease. In spite of great investments into the early diagnosis and management of breast cancer, late presentation persists and poses a barrier to realising the possible benefits of the gains made in breast cancer management. This study assessed the symptom appraisal and medical health seeking behaviour of women with either locally advanced or metastatic breast cancer attending breast clinic at KATH.

Method

In-depth interviews of women presenting with clinical stage III/IV breast cancer were conducted to explore the women’s care seeking pathways after symptom identification until arrival at KATH from May 2015 to March 2016. Thematic data analysis was conducted using the Andersen behavioural model for health service use.

Results

Fifteen women aged 24–79 years were interviewed. The time from symptom identification to reporting to KATH was 4–24 months. The initial symptom was a breast lump or breast swelling which all the women identified themselves. These were initially appraised as not serious because most importantly, they did not interfere with their daily function. Symptom progression such as prevented them from undertaking their usual economic, social and family function triggered seeking care from health facilities. The availability of money to pay for care and diagnostic investigations influenced the time taken to navigate the referral pathway. While the women initially deferred healthcare for reasons related to their ability to perform economic, family and social roles, ultimately, aggressively pursuing healthcare was also for the same economic, family and social reasons or goals.

Conclusion

Deciding to seek care and pursue treatment for breast cancer symptoms may be much more complicated than it appears. Economic, family and social function significantly drive the health seeking process both at the personal and health facility phases of health seeking. Breast cancer education messages must be adapted to incorporate these functional goals and their influence on symptom appraisal and decision making to seek help and not just focus on the breast symptom as an isolated entity.

Perceived Barriers to Early Detection of Breast Cancer in Iranian Women: A Qualitative Content Analysis

Background: Breast cancer is one of the most common cancers among Iranian women. The early diagnosis of this disease can decrease the mortality rate and promote patient survival. Objectives: This study aimed at identifying the barriers to early detection of breast cancer in Iranian women. Methods: In this qualitative study, which was extracted from a large research project, an exploratory sequential mixed-methods design was used, and conventional content analysis was carried out. Twenty-one participants were selected by purposeful sampling (ten health professionals and 11 female patients with breast cancer). Data were collected through in-depth, semi-structured interviews from July 2018 to June 2019. Results: The content analysis revealed three major themes related to delay in presentation: individual barriers (limited/lack of knowledge, other life preferences, negative reactions to the disease, and belief in fate), environmental barriers (insufficient social support, inaccurate information sources, and alternative therapy recommendations), and organizational barriers (poor quality of health services, inadequate access to health services, and role of media in informing people). Conclusions: Various perceived barriers, at different levels, play influential roles in the patients’ early detection. Therefore, collaboration between public health professionals, healthcare providers, and policymakers seems necessary for reducing delays in presentation among women.

Help-seeking behaviour for cancer symptoms: an evolutionary concept analysis

BACKGROUND

Cancer survival largely depends on its early diagnosis. Therefore, assessing help-seeking behaviours among people with potential symptoms of cancer is essential.

AIM

This study aimed to analyse the concept of help-seeking behaviour for cancer symptoms.

METHODS

This concept analysis was conducted using Rodger's evolutionary method. An online literature search was conducted in the PubMed, Scopus and Cochrane databases to find relevant articles published from 2000 to 2017 in English peer-reviewed journals. In total, ninety articles were included in the study. Through thematic analysis, the data were analysed for the definitions, attributes, antecedents and consequences of the concept of help-seeking behaviour for cancer symptoms.

RESULTS

The concept of help-seeking behaviour for cancer symptoms includes a chain of behaviours and is defined as the process of informed decision-making for seeking medical help and using healthcare services after the detection of the first potential cancer symptoms. The attributes of the concept of help-seeking behaviour for cancer symptoms include process, problem-centeredness, intentional action and interpersonal interaction. Antecedents of the concept of help-seeking behaviour for cancer symptoms were broadly categorised as its facilitators and barriers, among which old age, young age, marriage, low education level, positive family history of cancer, fear over cancer, low perceived threat, symptom disclosure to significant others are both facilitator and barrier. The consequences of the concept of help-seeking behaviour for cancer symptoms were also broadly categorised in the two main categories of positive consequences and adverse consequences.

CONCLUSIONS

Help-seeking behaviour is a multidimensional time-dependent and context-bound concept which is usually defined based on the concept of time in order to facilitate its measurement. It is generally used for assessing patients' delay in seeking medical help. The findings of this study provide better understanding about the concept of help-seeking behaviour for cancer symptoms and its implications for research and practice.

Developing a preventive psycho-oncology for a global context. The International Psycho-Oncology Society 2018 Sutherland Award Lecture

OBJECTIVE

Growing rates of cancer and survivorship, in situations of severe resource constraints, force a rethink about managing cancer-related psychosocial distress (CRPD). Here, a prevention-oriented natural history of distress is proposed, derived from developments in our understanding of the evolution and decay of CRPD.

METHODS

The literature indicates that at least four classes or natural histories of CRPD are identifiable. These are described in the context of prevention-oriented activities in psycho-oncology: (1) CRPD in persons with good coping resources, resulting from reaction to the diagnosis and treatment lifestyle disruption, which is largely self-limiting and preferably self-managed; (2) CRPD arising from residual, or late effects of disease or treatment, potentially persistent and debilitating; (3) CRPD in persons with preexisting coping difficulties; and (4) CRPD arising from existential issues such as mortality and fear of recurrence.

RESULTS

It is hypothesized that different natural histories of CRPD display different evolution, indicating potential causal processes, treatment priorities, and preventive strategies. In particular, the effective management of residual symptoms is crucial to prevent CRPD chronicity. Optimal patient involvement in treatment decision-making is also required.

CONCLUSIONS

There is a need to develop methods to differentiate if, early in the illness trajectory, the distressed patient is not able to self-manage the stress of cancer diagnosis and treatment. Not all distressed patients want or need help, and addressing just the CRPD may be inadequate where unresolved residual symptoms prevent renormalization after treatment. Improved doctor-patient communication around treatment decisions is warranted.

Recognizing and appraising symptoms of breast cancer as a reason for delayed presentation in Ghanaian women: A qualitative study

BACKGROUND

The burden of late presentation is well established in women presenting with advanced breast cancer in Africa. This paper aims to explore the reasons for delayed presentation in Ghanaian women with breast cancer.

METHOD

Eleven (11) women diagnosed with advanced breast cancer were purposively sampled within three years of diagnosis at the palliative care clinic of the Komfo Anokye Teaching Hospital, Ghana. Participation was voluntary. Data was collected through in-depth interviews using a self-devised semi-structured interview guide. The interviews were conducted in "Twi" (local language), audio-tape recorded and covered the women's journey from symptom discovery to their intention to seek help. All audio-taped interviews were transcribed based on the meaning of the respondents' comments. The data was managed using Nvivo version 11 qualitative software. Data was analyzed concurrently with data collection applying the principles of thematic analysis.

KEY FINDINGS

All the women delayed presentation due to overlapping reasons. Symptom appraisal among the women occurred in two main stages: individual understanding of breast symptom and interactive understanding of the breast symptom. These stages were based on cognitive, psycho-cultural and social factors. The five main themes generated from the data were: symptom experience, knowledge of breast cancer, role of social life and network, coping with a breast symptom and lastly intent to seeking health care. A conceptual model was developed to illustrate the relationships among the key factors and concepts emanated from this study.

CONCLUSION

Recognition and appraisal of breast cancer symptom in the eleven (11) Ghanaian women interviewed in this study was poor. For instance, a painless breast lump was considered not serious until a sensory symptom appears. This led women to experience appraisal and time point intervals. To minimize the incidence of late presentation of breast cancer cases in Ghana, adequate educational intervention should be provided for Ghanaian women and their social network, and other stakeholders.

Breast cancer screening behavior, attitude, barriers among middle-aged Chinese women in Macao, China

Background

Breast cancer is the third leading cause of death from cancer among females in Macao, but little is known about local practice of breast cancer screening. The study aims to evaluate breast cancer screening behaviors and to identify the predictors of insufficient knowledge and attitudes towards breast cancer and its screening among female residents.

Methods

This was a cross-sectional study conducted from April to June 2016 in Macao. Quota sampling of women completed the modified Chinese Breast Cancer Screening Beliefs questionnaire (CBCSB) to assess their breast cancer-related perceptions, screening attitudes and behaviors. Univariate and multivariate logistic regressions were performed to identify the predictors of poor-screening practices, attitudes, knowledge and perceived barriers to mammography.

Result

A total of 417 women (mean age±SD: 50.5±5.7) completed surveys, with 160 (38.4%), 196 (47.0%) and 103 (24.7%) women received breast self-examination, clinical breast examination and mammography as recommended, respectively. Nulliparity (OR=2.56, 95% CI = 1.14-5.73) and low education (OR = 1.72, 95% CI = 1.04-2.84) were significantly associated with negative attitude towards health check-ups. Women did not know anyone with breast cancer (OR = 2.30, 95% CI = 1.50-3.55) were more likely to have insufficient knowledge about breast cancer. Low education (OR = 1.95, 95% CI = 1.25-3.04) and not knowing anyone with breast cancer (OR = 2.02, 95% CI = 1.31-3.13) were identified as predictors for perceived barriers to mammography.

Conclusion

Recommendations for breast cancer screening are poorly followed by the residents in Macao, and a culturally tailored educational program is urgently needed to raise the public's awareness of the disease and the screening practices.

Mediating Factors in Early Diagnosis of Breast Cancer: from Initial Changes in Health to Breast Cancer Detection

Background:

Breast cancer is one of the most frequently occurring cancers in women throughout the world. In Iran, according to available reports, 70% of patients with breast cancer are detected at the advanced stages of the disease.

Materials and Methods:

This study is of descriptive-analytic cross-sectional type.160 female patients was selected. The data in this study was collected via face to face interview using a questionnaire based on the Anderson’s delay model. Data were analyzed using SPSS 22 and the significance level was considered to be 0.05.

Results:

The results showed that presence of mass was the first symptom in many of women, i.e., 76 cases (47.5%). not only the presence of mass in the breast, but also any other symptom, hadn’t been taken as a serious problem initially by women. Non-improvement of the symptoms and exacerbation of the symptoms was considered as a symptom of illness by patients. After considering the changes as the symptoms of illness, patients had tried to treat the disease through different methods of self-treatment. The failure of the self-treatment in controlling the symptoms, had directed the patients toward seeking for medical services. Out of 160 patients, 49 patients (39.6%) changed the time of their appointment with doctor. 110 cases (68%) out of 160 patients, rather than initiating relevant diagnostic procedure related to the disease, had received non-specific and non-related therapeutic measures.

Conclusion:

Pondering on the results yields that patient-related delays, resulting from their lack of awareness of the disease, cultural factors, and fear, can only play an important role in postponement of visiting a physician, but in the diagnosis of disease it is the inability of general practitioners in performing differential diagnoses, and making request for related diagnostic measures which can significantly increase the lag time until the onset of the main treatment.

Breast cancer screening behaviors among Chinese women in Mainland China

In the present study, we reported on the current breast cancer screening rates among Chinese women in China and examined whether demographic factors and cultural beliefs were associated with their screening behavior. A cross-sectional survey was conducted with a convenience sample of 494 Chinese women who completed the modified Breast Cancer Screening Beliefs Questionnaire (BCSBQ). Two-sample t-tests and multivariable logistic regression were employed to analyze the data. The results indicated that participation in screening practices ranged from 27.5% for breast self-examination (BSE), 36.4% for clinical breast examination, 23.5% for mammography, and 40% for ultrasonography. Women who had previously engaged in one of the four screening practices had significantly higher scores on the three subscales of the modified BCSBQ. Being older and having a friend who had been diagnosed with breast cancer were shown to be predictors for BSE and participation in either mammography or ultrasonography, respectively. Education levels were also shown to be positively associated with the four screening measures. We suggest that cultural beliefs about breast cancer and screening practices play a significant role in Chinese women's screening behavior.

Potential factors associated with clinical stage of nasopharyngeal carcinoma at diagnosis: a case-control study

Background

In China, most patients with nasopharyngeal carcinoma (NPC) are diagnosed at a late stage and consequently have a poor prognosis. This study aimed to investigate potential factors associated with the clinical stage of NPC at diagnosis.

Methods

Data were obtained from 118 patients with early-stage NPC and 274 with late-stage NPC who were treated at Sun Yat-sen University Cancer Center between August 2014 and July 2015. Patients were individually matched by age, sex, and residence, and a conditional logistic regression model was applied to assess the associations of clinical stage at diagnosis with socioeconomic status indicators, knowledge of NPC, physical examinations, patient interval, and risk factors for NPC.

Results

Although knowledge of early NPC symptoms, smoking cessation, and patient interval were important factors, the number of cigarettes smoked per day, motorbike ownership, and physical examination exhibited the strongest associations with the clinical stage of NPC at diagnosis. Compared with smoking fewer than ten cigarettes a day, smoking 10–30 cigarettes [odds ratio (OR) 4.03; 95% confidence interval (CI) 1.11–14.68] or more than 30 cigarettes (OR 11.46; 95% CI 1.26–103.91) was associated with an increased risk of late diagnosis. Compared with not owning a motorbike, owning a motorbike (OR 0.38; 95% CI 0.23–0.64) was associated with early diagnosis. Subjects who underwent physical examinations were less likely to receive a late diagnosis than those who did not undergo examinations (OR 0.50; 95% CI 0.28–0.89). However, indicators of wealth were not significant factors.

Conclusions

Initiatives to improve NPC patient prognosis should aim to promote knowledge about early symptoms and detection, health awareness, and accessibility to health facilities among all patients, regardless of socioeconomic status.

Breast cancer patient delay in Fukushima, Japan following the 2011 triple disaster: a long-term retrospective study

Background

Little information is available concerning how patient delay may be affected by mass disasters. The main objectives of the present study are to identify whether there was a post-disaster increase in the risk of experiencing patient delay among breast cancer patients in an area affected by the 2011 triple disaster in Fukushima, Japan, and to elucidate factors associated with post-disaster patient delay. Sociodemographic factors (age, employment status, cohabitant status and evacuation status), health characteristics, and health access- and disaster-related factors were specifically considered.

Methods

Records of symptomatic breast cancer patients diagnosed from 2005 to 2016 were retrospectively reviewed to calculate risk ratios (RRs) for patient delay in every year post-disaster compared with the pre-disaster baseline. Total and excessive patient delays were respectively defined as three months or more and twelve months or more from symptom recognition to first medical consultation. Logistic regression analysis was conducted for pre- and post-disaster patient delay in order to reveal any factors potentially associated with patient delay, and changes after the disaster.

Results

Two hundred nineteen breast cancer patients (122 pre-disaster and 97 post-disaster) were included. After adjustments for age, significant post-disaster increases in RRs of experiencing both total (RR: 1.66, 95% Confidence Interval (CI): 1.02–2.70, p < 0.05) and excessive patient delay (RR: 4.49, 95% CI: 1.73–11.65, p < 0.01) were observed. The RRs for total patient delay peaked in the fourth year post-disaster, and significant increases in the risk of excessive patient delay were observed in the second, fourth, and fifth years post-disaster, with more than five times the risk observed pre-disaster. A family history of any cancer was the only factor significantly associated with total patient delay post-disaster (odds ratio: 0.38, 95% CI: 0.15–0.95, p < 0.05), while there were no variables associated with delay pre-disaster.

Conclusions

The triple disaster in Fukushima appears to have led to an increased risk of patient delay among breast cancer patients, and this trend has continued for five years following the disaster.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3412-4) contains supplementary material, which is available to authorized users.

Breast cancer presentation delays among Arab and national women in the UAE: a qualitative study

Breast cancer (BC) is a disease that has improved prospects for survival if detected and treated early. Delayed help-seeking behavior, with poor survival as a consequence, is an important public health issue in the Middle East. More than 75% of breast cancer patients in the United Arab Emirates (UAE) seek medical advice after experiencing a sign or symptom of the disease and many seek such advice late. Our aim was to explore factors influencing delayed presentation for treatment after self-discovery of symptoms consistent with breast cancer in Arab women in the United Arab Emirates (UAE), and to explore facilitators and barriers of women’s health seeking behavior in the complex religiously dominated society of the UAE. A qualitative descriptive approach using semi-structured interviews was used. We interviewed nineteen BC survivors aged 35–70 who have experienced delayed presentation to treatment after symptomatic recognition of BC. The time interval between initial experience of symptoms consistent with BC, and taking action to seek medical help was between three months to three years. The key themes that emerged from the interviews were varying responses to symptom recognition, fear of societal stigmatization, and concerns regarding abandonment by spouse because of BC. Culture has a strong influence on the decisions of women in the UAE society. The lack of awareness about signs and symptoms of BC and routine screening has an important effect on symptom appraisal and subsequently decision making regarding options for treatment.

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Lack of awareness about breast health, screening, signs/symptoms and risk factors.

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Culture/societal values have great influence on women׳s attitudes and behaviors.

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Support of healthcare providers may reduce likelihood of delay.

Understanding pathways to breast cancer diagnosis among women in the Western Cape Province, South Africa: a qualitative study

OBJECTIVES

The aim of this study was to explore and understand women's pathways to breast cancer diagnosis and factors influencing this journey.

DESIGN AND SETTING

Indepth interviews were conducted with clients at a tertiary level breast cancer clinic in Cape Town, South Africa. A thematic analysis was performed underpinned by the theoretical concepts of the Model of Pathways to Treatment framework.

PARTICIPANTS

20 women were interviewed within 1 week of being diagnosed with breast cancer.

RESULTS

The average time between discovery of bodily changes to breast cancer diagnosis was 8.5 months. Deficits in breast self-awareness and knowledge of breast cancer symptoms delayed women's interpretation of bodily changes as being abnormal. All women first noticed breast lumps; however, many did not perceive it as abnormal until additional symptoms were present. General good health, attribution of symptoms to ageing, and past benign breast disease resulted in women being complacent about bodily changes. Disclosure to family members served as a trigger to seek healthcare. The initial type of primary level care services women accessed was influenced by perceptions of care each service provided, finances, structural factors, and personal safety related to the physical location of services.

CONCLUSIONS

Symptom appraisal and interpretation contributed significantly to delayed presentation. To improve timely diagnosis of breast cancer, interventions that increase women's confidence in detecting breast changes, improve knowledge of breast cancer symptoms, address myths, and encourage prompt help-seeking behaviour are required.

An introduction to key event mapping: A primer for nurse researchers

To fully understand the events leading to a diagnosis, retrospective recall can help nurse researchers reconstruct important health behavior-related events. However, retrospective recall can be a challenge. Key event mapping offers nurse researchers a method beyond retrospective chart review to elicit date data to explore the pre-diagnosis time frame of an illness. The purpose of this paper is to introduce the key event mapping method to nurse researchers in search of a method of eliciting date data from participants when designing research studies that include a retrospective recall component.

Help seeking behavior of women with self-discovered breast cancer symptoms: a meta-ethnographic synthesis of patient delay

Background and Objective

Patient delay makes a critical contribution to late diagnosis and poor survival in cases of breast cancer. Identifying the factors that influence patient delay could provide information for adopting strategies that shorten this delay. The aim of this meta-ethnography was to synthesize existing qualitative evidence in order to gain a new understanding of help seeking behavior in women with self-discovered breast cancer symptoms and to determine the factors that influence patient delay.

Methods

The design was a meta-ethnography approach. A systematic search of the articles was performed in different databases including Elsevier, PubMed, ProQuest and SCOPUS. Qualitative studies with a focus on help seeking behaviors in women with self-discovered breast cancer symptoms and patient delay, published in the English language between 1990 and 2013 were included. The quality appraisal of the articles was carried out using the Critical Appraisal Skills Programme qualitative research checklist and 13 articles met the inclusion criteria. The synthesis was conducted according to Noblit and Hare’s meta-ethnographic approach (1988), through reciprocal translational analysis and lines-of-argument.

Findings

The synthesis led to identification of eight repeated key concepts including: symptom detection, initial symptom interpretation, symptom monitoring, social interaction, emotional reaction, priority of medical help, appraisal of health services and personal-environmental factors. Symptom interpretation is identified as the important step of the help seeking process and which changed across the process through active monitoring of their symptoms, social interactions and emotional reactions. The perceived seriousness of the situation, priority to receive medical attention, perceived inaccessibility and unacceptability of the health care system influenced women’s decision-making about utilizing health services.

Conclusion

Help seeking processes are influenced by multiple factors. Educational programs aimed at correcting misunderstandings, erroneous social beliefs and improving self-awareness could provide key strategies to improve health policy which would reduce patient delay.

The symptom appraisal of breast cancer in the context of an intimate relationship

The purpose of this qualitative investigation was to understand how a self-detected breast abnormality is experienced within the context of an intimate relationship. Of specific interest were spousal interactions that influenced (facilitated or impeded) timely presentation for medical evaluation. Fourteen women who were in a relationship at the time of symptom discovery and seven of their male partners were interviewed. Interview transcripts were analyzed using the grounded theory method. Tenuous Knowing and Spiral of Disclosure defined two main processes that a woman negotiated within herself in relation to her partner upon discovery of a breast change.