A grounded explanation of why women present with advanced breast cancer

Abstract

Background: Advanced breast cancer presentation remains a large obstacle in lowering mortality rates in low- and middle-resource countries. This study aims to explore the reasons why women present with breast cancer at an advanced stage.

Methods: Purposive sampling of 19 breast cancer patients presenting with advanced cancer that were diagnosed within 2 years at the University Malaya Medical Centre, Kuala Lumpur, Malaysia. In-depth interviews were conducted, and audio-recordings were transcribed. Sample size was determined by theoretic sufficiency, and the constructivist grounded theory method was used.

Results: The reasons for delayed presentation can be displayed in two models. The total breast cancer delay (TBCD) model was derived from the journey of the patients. Four concepts emerged: (1) pluralistic health systems; (2) points of delay; (3) presence of patient or system delays, and (4) patient decision-making at each stage. Eight points of delay were found. At each point, evidence of a patient decision-making model emerged: the breast cancer delay explanatory (BCDE) model, which was the process of assessing severity and knowing and choosing options. The four main operational constructs were (1) knowledge on disease and disease outcomes, (2) knowledge of treatment and treatment outcomes, (3) psychological and physical resources and support; and (4) roles in decision-making.

Conclusions: The phenomenon is explained by the TBCD and BCDE models. Deconstructing why women present with advanced breast cancer and resist treatment provides clarity of the issues and opportunities for intervention.