Department of Dermatology, University Hospital of Bordeaux, 1, rue Jean Burguet, 33000, Bordeaux, France.
Paul Valéry Montpellier 3, University of Montpellier, EPSYLON EA 4556, Montpellier, France.
Arch Dermatol Res. 2021 Dec;313(10):829-835. doi: 10.1007/s00403-020-02175-x. Epub 2021 Jan 12.
Basal cell carcinoma is the most common skin cancer for which surgery is usually the unique and definitive treatment. Advanced basal cell carcinoma is not eligible to surgery when underlying structures are destroyed. Delayed consultation is the principal cause of advanced basal cell carcinoma. It is questionable why some patients seek care only when the tumour is advanced. The objective of this study was to identify the psychosocial factors involved in delayed consultation. We used a qualitative approach, conducting semi-structured interviews with advanced basal cell carcinoma patients and the healthcare staff of a dermatology unit to explore why some patients consult only when basal cell carcinoma is advanced. We then put our findings into perspective and created a logical model for change. We interviewed 14 patients and 12 healthcare staff. The first lesion was associated with banalization. Then, denial and fear of diagnosis or treatment were post common. Finally, the advanced basal cell carcinoma's symptoms, along with social pressure, created the intention to seek medical help and improved disease awareness. We developed a logical model that summarizes these findings. In this pilot study, we modelled factors that delayed consultation. This will aid future research and targeted interventions reducing delay, in particular by improving knowledge and by using social pressure as facilitators. Trial registration: NCT04124796.
基底细胞癌是最常见的皮肤癌，手术通常是唯一和明确的治疗方法。当底层结构被破坏时，晚期基底细胞癌不符合手术条件。延迟就诊是导致晚期基底细胞癌的主要原因。有些患者为什么只有在肿瘤晚期才寻求治疗，这令人质疑。本研究的目的是确定延迟就诊相关的社会心理因素。我们采用定性方法，对皮肤科单位的晚期基底细胞癌患者和医护人员进行半结构化访谈，以探讨为什么有些患者只有在基底细胞癌晚期才就诊。然后，我们将研究结果放在适当的位置，并为变革创建一个逻辑模型。我们采访了 14 名患者和 12 名医护人员。第一次发病与平淡化有关。然后，否认和害怕诊断或治疗是常见的。最后，晚期基底细胞癌的症状以及社会压力，促使他们寻求医疗帮助并提高了对疾病的认识。我们开发了一个逻辑模型来总结这些发现。在这项初步研究中，我们对导致延迟就诊的因素进行了建模。这将有助于未来的研究和有针对性的干预措施，以减少延迟，特别是通过提高知识水平，并利用社会压力作为促进因素。试验注册：NCT04124796。
