Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, UK.
Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, UK.
Eur J Oncol Nurs. 2020 Feb;44:101677. doi: 10.1016/j.ejon.2019.101677. Epub 2019 Oct 16.
Behaviour change interventions are more likely to be effective if they are sensitive to contextual determinants of behaviour. Delayed presentation of women with breast symptoms is a concern for both high-income and low- and medium-income countries. Our aim was to integrate evidence on determinants of time to presentation of women with breast symptoms with complementary evidence on interventions for promoting early presentation.
A systematic review was conducted according to PRISMA guidelines. Ten electronic databases were searched for relevant articles published between 1985 to May 2019. Pre-defined selection criteria were applied to retrieved records. Evidence on interventions, and on determinants were integrated through sequential explanatory synthesis design.
Of the 4185 documents retrieved, 11 intervention studies and 10 determinants studies were included in the synthesis. Overall, evidence on interventions is of low quality, while that on determinants is of medium quality. Intervention studies were mostly individual-level with almost exclusive focus on breast cancer awareness among postmenopausal women in high-income countries. Synthesis of evidence on determinants resulted in 10 domains. Juxtaposing the evidence on determinants of time to presentation of women with breast symptoms with that of the interventions to promote early presentation shows a mismatch between them.
Whilst there is strong evidence that women with breast symptoms face multi-level influences to presentation, current interventions have focused almost exclusively on breast cancer awareness in high-income countries. High quality multi-level interventions are required to promote early presentation of symptomatic women in different socio-cultural and economic settings.
如果行为改变干预措施对行为的情境决定因素敏感，则更有可能有效。女性出现乳房症状的时间延迟是高收入和中低收入国家都关注的问题。我们的目的是将有关女性乳房症状表现时间决定因素的证据与促进早期表现的干预措施的补充证据相结合。
根据 PRISMA 指南进行系统评价。在 1985 年至 2019 年 5 月期间，对十个电子数据库进行了相关文章的检索。应用预定义的选择标准对检索到的记录进行筛选。通过顺序解释性综合设计，对干预措施和决定因素的证据进行整合。
在检索到的 4185 篇文献中，有 11 项干预研究和 10 项决定因素研究被纳入综合分析。总体而言，干预措施的证据质量较低，而决定因素的证据质量中等。干预研究主要是个体层面的，几乎只关注高收入国家绝经后妇女的乳腺癌意识。对女性乳房症状表现时间决定因素的证据进行综合分析，得出了 10 个领域。将女性乳房症状表现时间的决定因素的证据与促进早期表现的干预措施的证据进行并列对比，发现两者之间存在不匹配。
尽管有强有力的证据表明，有乳房症状的女性面临多层次的就诊影响，但目前的干预措施几乎只关注高收入国家的乳腺癌意识。需要在不同的社会文化和经济背景下，制定高质量的多层次干预措施，以促进有症状女性的早期就诊。
