- Volume 15 Issue 19
DOI QR Code
Appraisal of Breast Cancer Symptoms by Iranian Women: Entangled Cognitive, Emotional and Socio-Cultural Responses
- Khakbazan, Zohreh (Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences) ;
- Roudsari, Robab Latifnejad (Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences) ;
- Taghipour, Ali (Health Sciences Research Center, Department of Biostatistics and Epidemiology, Faculty of Health, Mashhad University of Medical Sciences) ;
- Mohammadi, Eesa (Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University) ;
- Pour, Ramesh Omrani (Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University)
- Published : 2014.10.23
Background: Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. Materials and Methods: A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. Results: The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. Conclusions: This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.
Breast cancer;socio-cultural;entangled cognitive responses;Iranian women
- Teel CS, Meek P, McNamara AM, Watson L (1997). Perspectives unifying symptom interpretation. J Nurs Scholarship, 29, 175-81. https://doi.org/10.1111/j.1547-5069.1997.tb01553.x
- Unger Saldana K, Infante-Castaneda CB (2011). Breast cancer delay: A grounded model of help-seeking behaviour. Social Science and Medicine, 72, 1096-104. https://doi.org/10.1016/j.socscimed.2011.01.022
- Vahdaninia M, Montazeri A (2004). Breast cancer in Iran: a survival analysis. Asian Pac J Cancer Prev, 5, 223-5.
- Abdullah A, Abdullah KL, Yip CH, et al (2013). The decisionmaking journey of Malaysian women with early breast cancer: a qualitative study. Asian Pac J Cancer Prev, 14, 7143-7. https://doi.org/10.7314/APJCP.2013.14.12.7143
- Adam D, Soutar GN (2003). The impact of self-discovered breast changes: some qualitative evidence. Australian and New Zealand marketing academy conference (ANZMAC) N/A, 1920-1927.
- Arndt V, Sturmer T, Stegmaier C, et al (2003). Provider delay among patients with breast cancer in Germany: a populationbased study. J Clin Oncol, 21, 1440-6. https://doi.org/10.1200/JCO.2003.08.071
- Babu GR, Samari G, Cohen SP, et al (2011). Breast cancer screening among females in iran and recommendations for improved practice: a review. Asian Pac J cancer prev: APJCP, 12, 1647.
- Banning, M., and Hafeez, H. (2009). Perceptions of breast health practices in Pakistani Muslim women. Asian Pac J Cancer Prev, 10, 841-7.
- Facione NC (1993). Delay versus help seeking for breast cancer symptoms: a critical review of the literature on patient and provider delay. Soc Sci Med, 36, 1521-34. https://doi.org/10.1016/0277-9536(93)90340-A
- Bish A, Ramirez A, Burgess C, Hunter M (2005). Understanding why women delay in seeking help for breast cancer symptoms. J Psychosom Res, 58, 321-6. https://doi.org/10.1016/j.jpsychores.2004.10.007
- Burgess C, Hunter MS, Ramirez A J (2001). A qualitative study of delay among women reporting symptoms of breast cancer. Br J General Practice.
- de Nooijer J, Lechner L, de Vries H (2001). A qualitative study on detecting cancer symptoms and seeking medical help; an application of Andersen's model of total patient delay. Patient Educ Couns, 42, 145-57. https://doi.org/10.1016/S0738-3991(00)00104-X
- Dye TD, Bogale S, Hobden C, et al (2012). Experience of initial symptoms of breast cancer and triggers for action in Ethiopia. International J Breast Cancer, 2012.
- Faridhosseini F, Ardestani MS, Shirkhani F (2010). Disclosure of cancer diagnosis: what Iranian patients do prefer? Annals of General Psychiatry, 9, 165. https://doi.org/10.1186/1744-859X-9-S1-S165
- Gates MF, Lackey NR, Brown G (2001). Caring demands and delay in seeking care in African American women newly diagnosed with breast cancer: an ethnographic, photographic study. Oncol Nurs Forum, 28, 529-37.
- Ghiasvand R, Maram ES, Tahmasebi S, Tabatabaee SHR (2011). Risk factors for breast cancer among young women in southern Iran. Int J Cancer, 129, 1443-9. https://doi.org/10.1002/ijc.25748
- Granek L, Fergus K (2012). Resistance, agency, and liminality in women's accounts of symptom appraisal and help-seeking upon discovery of a breast irregularity. Social Science and Medicine.
- Grbich C (2012). Qualitative data analysis: An introduction: Sage.
- Harirchi I, Ghaemmaghami F, Karbakhsh M, Moghimi R, and Mazaherie H (2005). Patient delay in women presenting with advanced breast cancer: an Iranian study. Public Health, 119, 885-91. https://doi.org/10.1016/j.puhe.2004.11.005
- Montazeri A, Ebrahimi M, Mehrdad N, Ansari M, Sajadian A (2003). Delayed presentation in breast cancer: a study in Iranian women. BMC Women's Health, 3.
- Hsieh HF, Shannon SE (2005). Three approaches to qualitative content analysis. Qualitative health research, 15, 1277-88. https://doi.org/10.1177/1049732305276687
- Lam W, Tsuchiya M, Chan M, et al (2009). Help-seeking patterns in Chinese women with symptoms of breast disease: a qualitative study. J Public Health, 31, 59-68.
- Lu MH, Lin HR, Lee MD. (2010). The experiences among older taiwanese women facing a new diagnosis of breast cancer. Cancer Nursing, 33, 398-405. https://doi.org/10.1097/NCC.0b013e3181d72c45
- Montazeri A, Vahdaninia M, Harirchi I, et al (2008). Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods. Asia Pac Fam Med, 7, 6. https://doi.org/10.1186/1447-056X-7-6
- Nyawata ID, Topping AE (2006). Symptom interpretation as a source of delay in malignant melanoma presentation-A literature review. Clinical Effectiveness in Nursing, 9, 68-78. https://doi.org/10.1016/j.cein.2006.10.005
- O'Mahony M, Hegarty J (2009). Help seeking for cancer symptoms: a review of the literature. Oncol Nurs Forum, 36, 178-84. https://doi.org/10.1188/09.ONF.E178-E184
- O'Mahony M, Hegarty J, McCarthy G (2011). Women's help seeking behaviour for self discovered breast cancer symptoms. Eur J Oncol Nurs, 15, 410-8. https://doi.org/10.1016/j.ejon.2010.10.011
- Petrie K, JW. (2003). More focus needed on symptom appraisal. J Psychosom Res, 54, 401-93. https://doi.org/10.1016/S0022-3999(02)00461-0
- Rastad H, Khanjani N, Khandani BK (2012). Causes of delay in seeking treatment in patients with breast cancer in Iran: a qualitative content analysis study. Asia Pac J Cancer Prev, 13, 4511-5. https://doi.org/10.7314/APJCP.2012.13.9.4511
- Taib NA, Yip CH, Ibrahim M, Ng C, Farizah H (2007). Breast cancer in Malaysia: are our women getting the right message? 10 year-experience in a single institution in Malaysia. Asian Pac J Cancer Prev, 8, 141.
- Scott SE, McGurk M, Grunfeld EA (2007). The process of symptom appraisal: Cognitive and emotional responses to detecting potentially malignant oral symptoms. J Psychosomatic Res, 62, 621-30. https://doi.org/10.1016/j.jpsychores.2006.12.020
- Smith LK, Pope C, Botha JL (2005). Patients' help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet, 366, 825-31. https://doi.org/10.1016/S0140-6736(05)67030-4
- Taib NA, Yip CH, Low WY (2011). Recognising symptoms of breast Cancer as a reason for delayed presentation in Asian women-The Psycho-socio-cultural Model for breast symptom appraisal: opportunities for intervention. Asian Pac J Cancer Prev, 12, 1601-8.
- Correlation Study of Knowledge and Behavior Regarding Breast Care among Female Undergraduate Students in China vol.15, pp.24, 2015, https://doi.org/10.7314/APJCP.2014.15.24.10943
- Impact of a Breast Health Awareness Activity on the Knowledge Level of the Participants and its Association with Socio-Demographic Features vol.16, pp.14, 2015, https://doi.org/10.7314/APJCP.2015.16.14.5817
- Delay of Help Seeking Behavior for Symptomatic Breast Cancer Patients: A Concept Analysis vol.36, pp.0, 2016, https://doi.org/10.5630/jans.36.34
- Potential factors associated with clinical stage of nasopharyngeal carcinoma at diagnosis: a case–control study vol.36, pp.1, 2017, https://doi.org/10.1186/s40880-017-0239-y
- Radiation dose rate affects the radiosensitization of MCF-7 and HeLa cell lines to X-rays induced by dextran-coated iron oxide nanoparticles vol.93, pp.8, 2017, https://doi.org/10.1080/09553002.2017.1321806
- Patients’ help-seeking experiences and delaying in breast cancer diagnosis: A qualitative study pp.17427932, 2017, https://doi.org/10.1111/jjns.12173
- Recognizing and appraising symptoms of breast cancer as a reason for delayed presentation in Ghanaian women: A qualitative study vol.14, pp.1, 2019, https://doi.org/10.1371/journal.pone.0208773