Lam W W T, Tsuchiya M, Chan M, Chan S W W, Or A, Fielding R
School of Public Health, 5/F, WMW Mong Building, The University of Hong Kong, Hong Kong, PR China.
J Public Health (Oxf). 2009 Mar;31(1):59-68. doi: 10.1093/pubmed/fdn088. Epub 2008 Oct 23.
Prompt utilization of health services on detecting breast symptoms can improve breast cancer (BC) survival. Little is known about Chinese women's help-seeking behaviour. Our aim was to determine patterns of self-referral among Hong Kong Chinese women with self-detected breast symptoms.
We recruited 37 women awaiting their first consultation at public hospitals for breast symptoms. Interviews were transcribed and analysed based on the grounded theory approaches.
A two-stage help-seeking model provided the best interpretation of the data. Symptom recognition was triggered by symptom interpretation, symptom progression and social messages. Painful lumps were seen as symptomatic, but atypical symptoms were often dismissed as benign as they responded to dietary change. Symptom intensification and discussions with someone who had faced BC prompted consultation. Service utilization involved fear of consequences, confirmation need, symptom distress, lay referral, media prompts and opportunistic presentation. Fearing cancer as incurable delayed consultation. Utilization barriers included cost, uncertainty about referral pathways, competing priorities and embarrassment.
Atypical and painless presentation was more common among women delaying presentation. Barriers included cost, access, time and embarrassment. Education should emphasize atypical symptoms, the high-cure rate and the need for early presentation. Reduced cost and improved access to clinics would enhance early consultation.
在发现乳房症状时及时利用医疗服务可提高乳腺癌（BC）的生存率。对于中国女性的求助行为知之甚少。我们的目的是确定香港中国女性自我发现乳房症状后的自我转诊模式。
我们招募了37名因乳房症状在公立医院等待首次会诊的女性。访谈内容根据扎根理论方法进行转录和分析。
一个两阶段的求助模型对数据提供了最佳解释。症状识别由症状解读、症状进展和社会信息触发。疼痛性肿块被视为有症状，但非典型症状往往因饮食改变后症状缓解而被视为良性。症状加剧以及与患过乳腺癌的人讨论促使她们寻求会诊。服务利用涉及对后果的恐惧、确认需求、症状困扰、非专业转诊、媒体提示和机会性就诊。因恐惧癌症无法治愈而延迟会诊。利用障碍包括费用、转诊途径的不确定性、相互竞争的优先事项和尴尬。
非典型和无痛表现在延迟就诊的女性中更为常见。障碍包括费用、就诊机会、时间和尴尬。教育应强调非典型症状、高治愈率以及早期就诊的必要性。降低费用并改善诊所就诊机会将促进早期会诊。
