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

Abstract 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.

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Self-discovered breast cancer symptoms and women's help seeking behaviour: key findings from phase one of a two-phase study

10.33178/boolean.2010.29 ◽

2010 ◽

pp. 133-132

Author(s):

Mairin O’Mahony

Keyword(s):

Breast Cancer ◽

Health Care ◽

Health Care Professionals ◽

Help Seeking ◽

Western World ◽

Two Phase ◽

Cancer Symptoms ◽

Common Cancer ◽

Breast Symptom ◽

Help Seeking Behaviour

Breast cancer is the most common cancer among women in the western world. In Ireland, breast cancer was the most common cancer diagnosed amongst women during 2000-2004 with approximately 3,095 cases reported annually and an average of 947 deaths. It is well known that the earlier the diagnosis of breast cancer is made the more likely it is that women will have a better health outcome. However, 20-30% of women wait for one month or more before presenting to a Health Care Professional with a self discovered breast symptom. This is a worrying situation given the increased emphasis on prompt presentation of symptoms and the associated link with better health care outcomes for women diagnosed with breast cancer. Therefore, more work on help-seeking behaviour from the woman’s perspective will help Health Care Professionals to understand women’s needs and concerns surrounding symptom discovery and highlight the key issues linked to delayed ...

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Women’s help seeking behaviour for self discovered breast cancer symptoms

European Journal of Oncology Nursing ◽

10.1016/j.ejon.2010.10.011 ◽

2011 ◽

Vol 15 (5) ◽

pp. 410-418 ◽

Cited By ~ 22

Author(s):

Mairin O’Mahony ◽

Josephine Hegarty ◽

Geraldine McCarthy

Keyword(s):

Breast Cancer ◽

Help Seeking ◽

Cancer Symptoms ◽

Help Seeking Behaviour

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Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review

BMJ Global Health ◽

10.1136/bmjgh-2020-004213 ◽

2021 ◽

Vol 6 (2) ◽

pp. e004213

Author(s):

Grace McCutchan ◽

Bahr Weiss ◽

Harriet Quinn-Scoggins ◽

Anh Dao ◽

Tom Downs ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Cancer Treatment ◽

Help Seeking ◽

Middle Income ◽

Cancer Symptoms ◽

Middle Income Countries ◽

Help Seeking Behaviour ◽

Psychosocial Influences

IntroductionStarting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment.MethodsMixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate.ResultsOf 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments.ConclusionDue to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.

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Delays on Treatment and Associated Factors in a Cohort of Women Diagnosed With Breast Cancer in Rio De Janeiro, Brazil

Journal of Global Oncology ◽

10.1200/jgo.18.52600 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 60s-60s

Author(s):

I.F.d. Silva ◽

S.D.O. Monteiro ◽

R.J. Koifman

Keyword(s):

Breast Cancer ◽

Developing Countries ◽

Late Stage ◽

College Education ◽

Treatment Delay ◽

Medical Attention ◽

Time Interval ◽

Histopathological Diagnosis ◽

Stage At Diagnosis ◽

Negatively Associated

Background: The majority of breast cancer death occurs in developing countries. Mortality reductions achieved in the last decades in developed countries have not been reached in developing countries mainly because of a lack of access to early medical attention and delays on treatment. There are very few research studies on the reasons behind delayed medical attention for breast cancer in women in developing countries. Aim: To estimate the treatment delay, and associated factors, among women diagnosed with breast cancer treated on the National Cancer Institute in Rio de Janeiro, Brazil. Methods: A retrospective study on a cohort of 3220 women newly diagnosed with breast cancer between 2011 and 2013 was accomplished. Times from diagnose to treatment initiation were analyzed according to the Brazilian law for cancer patient treatment (≤ 60 > days). Association between sociodemographic, life style, clinical and treatment variables, and delays on treatment were estimated using X2-test and logistic regression model, with 95% confidential interval. Results: Over 50% of women was 50-69 years old, white (50.5%), presented early stage at diagnosis (63.8%), and refereed from public health service (76.9%). From those who had a histopathological diagnosis on the first visit at NCI (N=2,554), median time from diagnose to 1st treatment was 108 days, varying from 97 days (stage T0-2N>1-X/T3-4N0/X) to 133 days (stage Tis). Among those, prevalence of treatment delay was 89.1%; time interval > 30 days from diagnosis and 1st visit at NCI (OR=29.84; CI: 19.80-44.97) and age (50-69: OR=1.61; CI: 1.24-2.11, ≥70 years: OR=1.91; CI: 1.27-2.89) were statistically associated with treatment delay; while high education (OR=0.31; CI: 0.13-0.73) and late stage at diagnosis (OR=0.63; CI: 0.49-0.80) were negatively associate with treatment delay. Among those who arrived without diagnosis (n=666), prevalence of treatment delay was 34.7%. Considering the whole cohort (N=3220) age ≥70 years old (OR=1.42; 1.04-1.94), living outside Rio city (OR=1.53; 1.26-1.87), and chemotherapy (OR=1.44; 1.06-1.95) were positively associated with delay; while college education (OR=0.73; 0.57-0.94) and late stage (OR=0.71; 0.53-0.96) were negatively associated with treatment delay. Conclusion: Increased breast cancer treatment delay was observed among women who arrived with histopathological diagnosis. Time interval from diagnosis on the 1st visit at cancer center was the main factor associated to treatment delay, followed by old age; while high education level and late stage at diagnosis were negatively associated with treatment delays. Considering the whole cohort, old age, living outside Rio and chemotherapy were positively associated to delays on treatment, while college education level and late stage were negatively associated with treatment delay.

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Impact of mild traumatic brain injury understanding on intended help-seeking behaviour

Journal of Child Health Care ◽

10.1177/1367493518799617 ◽

2018 ◽

Vol 24 (1) ◽

pp. 78-91 ◽

Cited By ~ 1

Author(s):

Natalie Feary ◽

Audrey McKinlay

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Help Seeking ◽

Close Friend ◽

Medical Attention ◽

Future Research ◽

Behavioural Intentions ◽

Help Seeking Behaviour ◽

Child Age

Children do not always receive adequate medical attention following a mild traumatic brain injury (mTBI), despite the necessity of this treatment. Adult mTBI knowledge may be one factor that affects if a child receives medical attention, but little is known about association between mTBI knowledge and help-seeking behaviour. Participants were 212 females and 58 males, including 84 parents, with a mean age of 35.57 years (standard deviation = 10.96). A questionnaire evaluated participants’ understanding of mTBI and vignettes to evaluate behavioural intentions regarding help-seeking behaviour after an mTBI. Only 40.0% of participants were able to recall an adequate number of mTBI symptoms (5+). Surprisingly, mTBI history was not associated with better mTBI knowledge, t(df, 268) = 1.29, p = .20. Similarly, knowing a close friend or family member with mTBI was not associated with higher mTBI knowledge, t(df = 268) = .81, p = .4. Further, neither mTBI symptom knowledge nor vignette child age (young = 5 years, older = 15 years) significantly predicted participants’ cited intentions to perform help-seeking behaviour. Consistent with the existing research, the current study demonstrates a continued lack of mTBI knowledge in the general population. However, this may not be a factor that influences an adult’s decision to take a child to hospital following mTBI. Future research should investigate the association between help-seeking intentions and actual behaviour in relation to paediatric mTBI.

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Individual utilisation thresholds and exploring how GPs’ knowledge of their patients affects diagnosis: a qualitative study in primary care

British Journal of General Practice ◽

10.3399/bjgp17x690509 ◽

2017 ◽

Vol 67 (658) ◽

pp. e361-e369 ◽

Cited By ~ 2

Author(s):

Matthias Michiels-Corsten ◽

Stefan Bösner ◽

Norbert Donner-Banzhoff

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Help Seeking ◽

Family Background ◽

Diagnostic Reasoning ◽

Medical Attention ◽

Diagnostic Strategies ◽

Help Seeking Behaviour ◽

The Media ◽

Serious Disease

BackgroundOne of the tenets of general practice is that continuity of care has a beneficial effect on patient care. However, little is known about how continuity can have an impact on the diagnostic reasoning of GPs.AimTo explore GPs’ diagnostic strategies by examining GPs’ reflections on their patients’ individual thresholds for seeking medical attention, how they arrive at their estimations, and which conclusions they draw.Design and settingQualitative study with 12 GPs in urban and rural practices in Germany.MethodAfter each patient consultation GPs were asked to reflect on their diagnostic reasoning for that particular case. Qualitative and quantitative analyses of consultations and interview content were undertaken.ResultsA total of 295 primary care consultations were recorded, 134 of which contained at least one diagnostic episode. When elaborating on known patients, GPs frequently commented on how ‘early’ or ‘late’ in an illness progression a patient tended to consult. The probability of serious disease was accordingly regarded as high or low. This influenced GPs’ behaviour regarding further investigations or referrals, as well as reassurance and watchful waiting. GPs’ explanations for a patient’s utilisation threshold comprised medical history, the patient’s characteristics, family background, the media, and external circumstances.ConclusionThe concept of an individual threshold for the utilisation of primary care would explain how GPs use their knowledge of individual patients and their previous help-seeking behaviour for their diagnostic decision making. Whether the assumption behind this concept is valid, and whether its use improves diagnostic accuracy, remains to be investigated.

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BREAST CANCER KNOWLEDGE AMONG NURSING STUDENTS IN PUBLIC UNIVERSITY

The Malaysian Journal of Nursing ◽

10.31674/mjn.2018.v10i01.001 ◽

2018 ◽

Vol 10 (1) ◽

pp. 3-7

Author(s):

Husbani Bt. Mohd Amin Rebuan ◽

Myat Moe ◽

Nur Qamilah Mohamad ◽

Nurulhuda Mat Hassan ◽

Hamidah Binti Othman

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Nursing Students ◽

High Risk ◽

Breast Carcinoma ◽

Screening Method ◽

Medical Attention ◽

Breast Self Examination ◽

Cancer Symptoms ◽

Self Examination

Background: In Malaysia, women had breast cancer always reported at their late stage. One of the causes is due to the delay in seeking medical attention. Poor knowledge about the breast cancer is one of the factors that cause the delay. Aim: This study was designed to assess the knowledge on breast cancer symptoms and risk factors, screening method, and practice among participants. Methodology: This was a cross-sectional study done from 1st of March till 15th of March 2016 involving 89 nursing students from School of Nursing Science, Medical Faculty, University Sultan Zainal Abidin (UniSZA). Data analysis was carried out using Statistical Package for the Social Sciences (SPSS) Version 21. Results: Eighty-nine participants responded. Majority of the students (>80.0%) knew the symptoms of breast cancer and common method of screening. Less than 50.0% knew the high risk factor for developing breast carcinoma. Less than 50.0% carried out the breast self-examination. Conclusion: Students had excellent knowledge on symptoms of breast carcinoma and its screening method. Majority (>50%) of the students were still not clear about high risk factors group. Lack of breast self-examination practice among students was noted.

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