Religiosity, Spirituality, and Cancer Fatalism Beliefs on Delay in Breast Cancer Diagnosis in African American Women

Abstract

African American women are more likely than any other racial or ethnic group to present with a later stage of breast cancer at initial diagnosis. Delay in breast cancer detection is a critical factor in diagnosis at a later stage. Available data indicate a delay of 3 months or more is a significant factor in breast cancer mortalty. Numerous factors have been reported as contributing to delay in time to seek medical care including religiosity, spirituality, and fatalistic beliefs. This study examined the influence of religiosity, spirituality, and cancer fatalism on delay in diagnosis and breast cancer stage in African American women with self-detected breast symptoms. A descriptive correlation, retrospective methodology using an open-ended questionnaire and three validated measurement scales were used: the Religious Problem Solving Scale (RPSS), the Religious Coping Activity Scale (RCAS) subscale measuring spiritually based coping, and the modified Powe Fatalism Inventory (mPFI). A convenience sample of 129 women ages between 30 and 84 years who self-reported detecting a breast symptom before diagnosis of breast cancer within the preceding 12 months were included in the study. Outcome variables were time to seek medical care and breast cancer stage. Other variables of interest included marital status, income, education, insurance status, and to whom the women spoke about their breast symptoms. Data were analyzed using descriptive statistics, logistic regression analysis, Pearson r correlations, Mann-Whitney U analysis, and Chi Square analysis. Participants were found to be highly religious and spiritual but not fatalistic. While most women delayed more than 3 months in seeking medical care, no associations were found between the three predictor variables and time to seek medical care. The median delay in time from self detection of a breast symptom to seeking medical care was 5.5 months. Women who were less educated, unmarried, and talked to God only about their breast change were significantly more likely to delay seeking medical care. An association was found between disclosing a breast symptom to God only and delay in seeking medical care. In contrast, women who had told a person about their breast symptom were more likely to seek medical care sooner. African American women who delayed seeking medical care for longer than 3 months were more likely to present with a later stage of breast cancer than women who sought care within 3 months of symptom discovery.

Effect of care-delivery delay on the survival of Mexican women with breast cancer

“…29 One study showed that women with greater delays in seeking medical care were diagnosed in advanced stages of the disease (OR=6.37, 95% CI: 2.84-14.30). 36 Another study revealed a median patient delay of 16 days, a shorter interval than that reported in our study. Another finding was that in women with well-differentiated tumors, the proportion of advanced-stage tumors did not change when the delay increased (p-trend=0.83), whereas in women with poorly differentiated tumors, this trend was monotonic (p-trend=0.03).…”

Medicine for the Spirit: Religious Coping in Individuals with Medical Conditions

“…Among cancer patients in England, claiming to have a faith was linked to less perceived importance of health information [16]; if patients do not value health information, they may not obtain it and may therefore be less able to engage in health-protective behaviors. Over a quarter of a sample of African American women with breast cancer said they had only told God about their symptoms; these women reported greater delays in seeking medical care [52]. Samuel-Hodge et al [50] likewise noted that in African Americans with diabetes, church attendance was related to taking less action to address the illness.…”

Neighborhood-level Influences on Delays in Diagnostic Follow-up from Mammography Screening in African-American Women: A Systematic Review

“…In Fair et al study of 76 medically-underserved women age >40 years with inadequate follow-up imaging or biopsy (≥ 6 months since mammogram results), 48% of African-American women perceived low benefits and high barriers to follow-up from screening and care, and reported a decrease in internal health locus of control. Gullatte et al [8] and Lannin et al [9] reported that African-American women held fatalistic views, coupled with fears of finding cancer accounted for delays in follow-up from abnormal MS. Several researchers found that "wait time' in ambulatory settings prohibited follow-up from abnormal MS in African-American women [4,10,11]. Similar to the previous findings, Jones et al [12] found that 'wait time' was much longer for racial and ethnic minority patients being served in public-hospitals than private hospitals with the majority White patients (94 days vs. 77 days).…”