埃塞俄比亚患者、家属和医疗保健提供者对乳腺癌晚期诊断的看法：一项定性研究。
Perspectives of patients, family members, and health care providers on late diagnosis of breast cancer in Ethiopia: A qualitative study.
机构信息
Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia.
School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
PLoS One. 2019 Aug 1;14(8):e0220769. doi: 10.1371/journal.pone.0220769. eCollection 2019.
BACKGROUND
Most women with breast cancer in Ethiopia are diagnosed at an advanced stage of the disease, but the reasons for this have not been systematically investigated. This study, therefore, aimed to explore the main reasons for diagnosis of advanced stage breast cancer from the perspective of patients, family members, and health care providers.
METHODS
A qualitative study with in-depth interviews was conducted with 23 selected participants at Tikur Anbessa Specialized Hospital, Oncology Clinic using a semi-structured interview guide. These participants were 13 breast cancer patients, 5 family members, and 5 health care providers. Data were transcribed into English, coded and analyzed using thematic analysis.
RESULTS
Awareness about the causes, risk, initial symptoms, early detection methods, and treatment of breast cancer were uncommon, and misconceptions about the disease prevailed among breast cancer patients and family members. There was a sense of hopelessness and uncertainty about the effectiveness of conventional medicine amongst patients and family members. Consequently, performing spiritual acts (using holy water) or seeking care from traditional healers recurred amongst the interviewees. Not taking initial symptoms of breast cancer seriously by the patients, reliance on traditional medicines, competing priorities, financial hardship, older age, fear of diagnosis of cancer, and weak health systems (e.g., delay in referral and long waiting period for consultation) were noted as the main contributors to late diagnosis. In contrast, persuasion by family members and friends, higher educational attainment, and prior experience of neighboring women with breast cancer were mentioned to be facilitators of early diagnosis of breast cancer.
CONCLUSIONS
The causes of late diagnosis of breast cancer in Ethiopia are multi-factorial and include individual, cultural, and health system factors. Interventions targeting these factors could alleviate the misconceptions and knowledge gap about breast cancer in the community, and shorten waiting time between symptom recognition and diagnosis of breast cancer.
背景
在埃塞俄比亚，大多数乳腺癌女性都是在疾病晚期才被诊断出来，但尚未系统地调查过导致这种情况的原因。因此，本研究旨在从患者、家属和医疗保健提供者的角度探讨诊断为晚期乳腺癌的主要原因。
方法
采用深度访谈的定性研究方法，在提克里州安贝萨专科医院肿瘤科使用半结构式访谈指南对 23 名选定的参与者进行了访谈。这些参与者包括 13 名乳腺癌患者、5 名家属和 5 名医疗保健提供者。数据被转录为英文，使用主题分析进行编码和分析。
结果
患者和家属对乳腺癌的病因、风险、初始症状、早期检测方法和治疗方法的认识不足，对该病存在误解。患者和家属对传统医学的疗效感到无望和不确定。因此，患者和家属中普遍存在进行精神行为（使用圣水）或寻求传统治疗师治疗的情况。患者对乳腺癌的初始症状不够重视、依赖传统药物、优先事项冲突、经济困难、年龄较大、害怕被诊断为癌症、以及薄弱的卫生系统（例如，转诊延误和咨询等待时间长）等是导致晚期诊断的主要原因。相比之下，家属和朋友的劝说、较高的教育程度和附近患有乳腺癌的女性的先前经历被认为是促进早期诊断乳腺癌的因素。
结论
埃塞俄比亚乳腺癌晚期诊断的原因是多方面的，包括个人、文化和卫生系统因素。针对这些因素的干预措施可以减轻社区对乳腺癌的误解和知识差距，并缩短从症状识别到乳腺癌诊断的等待时间。
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