Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
BMC Cancer. 2020 Oct 19;20(1):1011. doi: 10.1186/s12885-020-07520-x.
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.
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.
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.
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.
加纳科福阿訇教学医院（KATH）约 85%的乳腺癌患者就诊时已处于 III/IV 期。尽管在乳腺癌的早期诊断和管理方面投入了大量资金，但仍存在就诊时间晚的情况，这成为实现乳腺癌管理成果的可能收益的障碍。本研究评估了在 KATH 乳腺科就诊的局部晚期或转移性乳腺癌女性的症状评估和医疗保健寻求行为。
对 2015 年 5 月至 2016 年 3 月期间出现临床 III/IV 期乳腺癌的女性进行深入访谈，以探讨女性在出现症状后至到达 KATH 就诊的就医途径。使用安德森行为模型对健康服务利用进行主题数据分析。
共访谈了 15 名年龄在 24-79 岁的女性。从症状识别到向 KATH 报告的时间为 4-24 个月。最初的症状是乳房肿块或乳房肿胀，所有女性均自行发现。这些最初被评估为不严重，因为最重要的是，它们不会干扰她们的日常功能。症状进展，如妨碍她们从事日常经济、社会和家庭功能，促使她们到医疗机构寻求医疗服务。是否有资金支付医疗和诊断性检查影响了寻求转诊途径的时间。虽然女性最初因自身经济、家庭和社会角色的能力而推迟医疗保健，但最终，积极追求医疗保健也是出于相同的经济、家庭和社会原因或目标。
决定是否寻求医疗保健和治疗乳腺癌症状可能比看起来要复杂得多。经济、家庭和社会功能在个人和寻求医疗保健的医疗机构阶段均显著影响寻求医疗保健的过程。乳腺癌教育信息必须进行调整，以纳入这些功能目标及其对症状评估和寻求帮助的决策的影响，而不仅仅关注孤立的乳房症状。
