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

Abstract

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.

Pathways to Breast Cancer Diagnosis and Treatment Among Women in Ghana: A Qualitative Study

“…Two studies described women's symptom recognition, appraisal and intent to seek medical care, whereas the third described the diagnosis and treatment procedures. 4 , 7 , 8 However, no study has outlined in detail the pathways that women in Ghana navigate from symptom detection through treatment receipt. Understanding this full process and appreciating women's understanding and needs is essential if effective interventions are to be developed.…”

What influences cancer treatment service access in Ghana? A critical interpretive synthesis

“…Four studies23 28–30 demonstrated that high cost of medical treatment led to use of herbal and traditional alternatives. Prioritisation of finances on family led to delays in accepting treatment 23 24 31. Financial barriers impacted negotiation of care31; those from a lower income were more likely to experience longer wait times 32…”

“…Prioritisation of finances on family led to delays in accepting treatment. 23 24 31 Financial barriers impacted negotiation of care 31 ; those from a lower income were more likely to experience longer wait times. 32 Fears and beliefs about treatment and its outcomes Obrist et al 33 found patients who believed in the efficacy of treatment were more likely to complete treatment in single variable analysis, although this was not significant in multivariate models where potential confounding factors were controlled for.…”

Factors affecting delay in the presentation of breast cancer symptoms among women in Gaza, occupied Palestinian territory: a cross-sectional survey

“…Symptom interpretation is the most important step in seeking medical help and is believed to encourage up to 80% of women in seeking medical help. 23 Women cannot, however, be expected to know which symptoms they should act on and present to any healthcare system in the absence of co-ordinated awareness programmes driven by that system. These programmes need to be based on women’s experiences of a breast cancer symptoms and diagnosis and to be developed and evaluated for acceptability in collaboration with women from the relevant communities.…”