Facione N C, Dodd M J, Holzemer W, Meleis A I
Department of Physiological Nursing, School of Nursing, University of California San Francisco 94143, USA.
Cancer Pract. 1997 Jul-Aug;5(4):220-7.
Most breast cancer symptoms are discovered by women themselves, and at least one third of these women will be aware of their symptoms for 3 months or more before seeking an initial provider evaluation. The authors identify personal, social, and environmental influences on women's intention to seek an immediate provider evaluation (helpseek) versus to delay evaluation of a breast symptom that worried them.
Black women (N = 352) from the San Francisco Bay are women's organizations, community settings, and churches formed this convenience sample. Participants ranged across age, income, and educational levels. The survey contained 10 scales that measured health behavior variables, including new and existing scales augmented by items derived from prior interview and focus group investigations.
Women of younger age and lower income were significantly less likely to intend to seek an evaluation for self-discovered breast symptoms. Single and partnered women were less likely to seek a provider evaluation than married or widowed women. Perceiving negative consequences of delaying, having previous habits of healthcare utilization, perceiving access to services, and feeling fearful were positively related to the intention to seek evaluation of breast symptoms. Holding fatalistic beliefs about getting breast cancer or dying and perceiving constraints to seeing a provider negatively influenced helpseeking intention. Racism in the healthcare delivery system was perceived, but was not a significant influence on helpseeking intention. A multiple linear regression model containing these variables explained 46% of the variance in helpseeking intention.
This study shows that the intent to helpseek is not merely a matter of education and economics, but is dependent on a complex picture of personal, social, and economic factors. Gynecologic and primary care providers should consider this and the potential influences on helpseeking in the women for whom they provide cancer screening and early detection services. History taking should be expanded to assess women's ideas about the consequences of delaying evaluation of self-discovered breast symptoms, their sense of vulnerability to breast cancer, the constraints on cancer early detection they may be feeling related to role obligations, their economic or strategic limitations to accessing services, the pressures they may feel to hide a breast cancer symptom, or their own tendency to interpret the breast symptom as not threatening. Healthcare providers should not assume that helpseeking for breast symptoms is an automatic behavior for all women. Rather, providers should assess whether a women is the one in three who will delay the evaluation of a breast cancer symptom she discovers herself for months or years.
大多数乳腺癌症状是由女性自身发现的，并且这些女性中至少有三分之一在寻求医疗服务提供者的初步评估之前会意识到自己的症状达3个月或更长时间。作者确定了个人、社会和环境因素对女性立即寻求医疗服务提供者评估（寻求帮助）的意愿与延迟对困扰她们的乳房症状进行评估的意愿的影响。
来自旧金山湾区的黑人女性（N = 352）通过妇女组织、社区场所和教会组成了这个便利样本。参与者年龄、收入和教育水平各异。该调查包含10个量表，用于测量健康行为变量，包括通过先前访谈和焦点小组调查得出的项目扩充的新量表和现有量表。
年龄较小和收入较低的女性打算对自我发现的乳房症状进行评估的可能性显著较低。单身和有伴侣的女性比已婚或丧偶女性寻求医疗服务提供者评估的可能性更小。感知到延迟的负面后果、有先前的医疗利用习惯、感知到获得服务的机会以及感到恐惧与寻求乳房症状评估的意愿呈正相关。对患乳腺癌或死亡持有宿命论信念以及感知到寻求医疗服务的限制对寻求帮助的意愿有负面影响。察觉到医疗保健提供系统中的种族主义，但这对寻求帮助的意愿没有显著影响。包含这些变量的多元线性回归模型解释了寻求帮助意愿中46%的方差。
本研究表明，寻求帮助的意愿不仅仅是教育和经济问题，而是取决于个人、社会和经济因素的复杂情况。妇产科和初级保健提供者应考虑到这一点以及对他们为其提供癌症筛查和早期检测服务的女性寻求帮助的潜在影响。病史采集应加以扩展，以评估女性对于延迟自我发现的乳房症状评估后果的看法、她们对患乳腺癌的易感性、她们可能因角色义务而感到的癌症早期检测限制、她们获得服务的经济或策略性限制、她们可能因隐瞒乳腺癌症状而感受到的压力，或者她们自己将乳房症状解读为无威胁的倾向。医疗保健提供者不应假定所有女性都会自动寻求乳房症状的帮助。相反，提供者应评估一名女性是否属于那三分之一会将自己发现的乳腺癌症状延迟数月或数年评估的人。
