Abstract
BackgroundAbout 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.MethodIn-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.ResultsFifteen 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.ConclusionDeciding 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.
Highlights
About 85% of breast cancer patients attending Komfo Anokye Teaching Hospital (KATH), Ghana, present with stage III/IV disease
Even where the intended and actual meanings are congruent, Granek and Fergus [45] in their discussion of issues of agency and liminality associated with women’s symptom appraisal and help-seeking behaviour upon discovery of a breast symptom, assert that women who are not ready to present their breast symptoms to a physician remain ‘deliberately ignorant’ of it because they have other areas in their life that needs attention and that are not hindered by the threat of breast cancer, or the early symptoms of breast disease
Whilst this assertion may be true in some cases, the findings from this study suggest that women are not necessarily deliberately ignorant
Summary
About 85% of breast cancer patients attending Komfo Anokye Teaching Hospital (KATH), Ghana, present with stage III/IV disease. 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. Breast cancer diagnosis at a late stage is a challenge in low and middle-income countries, with 30–98% of breast cancer cases diagnosed at stage III or IV [1]. In some African countries, 70–80% of breast cancer patients present late [2,3,4]. At the Komfo Anokye Teaching Hospital (KATH) in Ghana, about 85% of breast cancer patients present with stage III/IV disease [7]
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