Help Seeking Behavior of Women with Self-Discovered Breast Cancer Symptoms: A Meta-Ethnographic Synthesis of Patient Delay

Abstract

Background and ObjectivePatient 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. MethodsThe 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.FindingsThe 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.ConclusionHelp 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.

A framework for improving early detection of breast cancer in sub-Saharan Africa: A qualitative study of help-seeking behaviors among Malawian women

“…This is consistent with findings from a review of pathology reports that nearly half of Malawian breast cancer patients experienced multiple symptoms for over 1 year before being diagnosed [29]. Symptom appraisal and cancer knowledge have been cited as factors of delay and cancer behaviors in studies worldwide [8, 9, 13, 20]. Other studies from low- and middle-income countries outside of Africa support these findings, especially that perceiving symptoms as non-threatening can delay diagnosis [12, 30].…”

“…However, few studies from Africa, where health resources are scarce, cancer awareness is low, and screening is uncommon, have been conducted or included in such reviews. Previous qualitative studies are largely descriptive, and few developed conceptual models to understand the complex factors influencing delayed and early detection [10, 12, 13]. Additionally, few delay models have explored the influence of alternative treatments and traditional medicine, which are commonly used among cancer patients across Africa [14].…”

Multilevel Factors Affecting Time to Cancer Diagnosis and Care Quality in Botswana

“…Similarly, studies among breast cancer patients in Egypt and Malawi found that informational and emotional support and social networks more generally were important influences on patients’ health‐seeking decisions and behaviors . Symptom disclosure was often linked with timely health‐seeking in a metaethnographic synthesis of breast cancer delay studies , which is similar to our finding that social support facilitated faster cancer care patterns. Therefore, information, education, and communication strategies should target the general population to increase awareness broadly and leverage communication and relationships through social networks.…”

Temperament, Beliefs About Pain Control, and Pain Intensity in Endometriosis Patients

“…Many sociodemographic factors such as age, low socioeconomic status, area of residence, and appraisal of health services may be associated with some women delaying seeking medical consultation (Kannan & Veazie, 2015; Khakbazan, Taghipour, Latifnejad Roudsari, & Mohammadi, 2014; Robinson, Christensen, Ottesen, & Krasnik, 2011). Several factors associated with help-seeking delay include psychological factors such as: lack of awareness and knowledge of the disease, disease beliefs, treatment beliefs, and emotional distress (Iskandarsyah et al, 2014).…”