Recognizing and appraising symptoms of breast cancer as a reason for delayed presentation in Ghanaian women: A qualitative study

BackgroundThe burden of late presentation is well established in women presenting with advanced breast cancer in Africa. This paper aims to explore the reasons for delayed presentation in Ghanaian women with breast cancer.MethodEleven (11) women diagnosed with advanced breast cancer were purposively sampled within three years of diagnosis at the palliative care clinic of the Komfo Anokye Teaching Hospital, Ghana. Participation was voluntary. Data was collected through in-depth interviews using a self-devised semi-structured interview guide. The interviews were conducted in “Twi” (local language), audio-tape recorded and covered the women’s journey from symptom discovery to their intention to seek help. All audio-taped interviews were transcribed based on the meaning of the respondents’ comments. The data was managed using Nvivo version 11 qualitative software. Data was analyzed concurrently with data collection applying the principles of thematic analysis.Key findingsAll the women delayed presentation due to overlapping reasons. Symptom appraisal among the women occurred in two main stages: individual understanding of breast symptom and interactive understanding of the breast symptom. These stages were based on cognitive, psycho-cultural and social factors. The five main themes generated from the data were: symptom experience, knowledge of breast cancer, role of social life and network, coping with a breast symptom and lastly intent to seeking health care. A conceptual model was developed to illustrate the relationships among the key factors and concepts emanated from this study.ConclusionRecognition and appraisal of breast cancer symptom in the eleven (11) Ghanaian women interviewed in this study was poor. For instance, a painless breast lump was considered not serious until a sensory symptom appears. This led women to experience appraisal and time point intervals. To minimize the incidence of late presentation of breast cancer cases in Ghana, adequate educational intervention should be provided for Ghanaian women and their social network, and other stakeholders.研究背景：非洲地区晚期乳腺癌女性患者的就诊延误负担已得到广泛证实。本研究旨在探究加纳乳腺癌女性患者就诊延误的原因。 研究方法：本研究于加纳科姆福·阿诺克教学医院姑息治疗门诊招募确诊后三年内的晚期乳腺癌女性患者共11例，采用目的抽样法。参与者均为自愿参与。本研究通过自行编制的半结构化访谈提纲开展深度访谈以收集数据，访谈使用当地特维语（Twi）进行，采用录音记录，访谈内容覆盖受试者从发现症状到寻求医疗帮助的完整历程。所有录音访谈均根据受访者表述的语义进行转录。数据管理采用NVivo 11质性分析软件完成，研究同时遵循主题分析法原则，在数据收集的同步阶段开展数据分析。 主要研究结果：所有受试者的就诊延误均由多重重叠因素导致。受试者的症状评估主要分为两个阶段：对乳腺症状的个体认知与交互性认知，上述阶段均受认知、社会心理文化及社会因素影响。本研究从数据中提炼出五大核心主题：症状体验、乳腺癌认知、社会生活与社交网络的作用、乳腺症状应对方式，以及寻求医疗救助的意愿。本研究构建了概念模型，用以阐释本研究得出的关键因素与概念间的关联关系。 研究结论：本研究访谈的11名加纳女性乳腺癌患者对乳腺癌症状的识别与评估能力普遍不足。例如，无痛性乳腺肿块在出现感觉性症状前，常被认为并不严重，这导致受试者出现了症状评估与就诊时间间隔延迟的问题。为降低加纳地区乳腺癌晚期就诊病例的发生率，应为加纳女性及其社交网络、其他相关利益方提供充分的教育干预措施。