From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study
From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study
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DOI：
10.1186/s12885-018-4219-7
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发表时间：
2018-03-21
期刊：
影响因子：
3.8
通讯作者：
Constant, Deborah
中科院分区：
文献类型：
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作者：
Moodley, Jennifer;Cairncross, Lydia;Constant, Deborah
背景：通常情况下，南非（SA）的妇女在自我出现症状时被诊断为乳腺癌。本研究的目的是确定妇女遵循乳腺癌护理的途径和与此journey.Methods相关的因素：在西开普省，SA，2015年5月和2016年5月之间的三级医院进行了横断面研究。对新诊断的乳腺癌患者进行了访谈，以确定其社会人口学特征;风险因素，体征和症状的知识;乳房变化的评估;临床特征和;护理过程中的关键时间事件。治疗途径框架模式是分析的基础。将女性注意到首次乳房变化与计划治疗日期之间的总时间（TT）分为3个间隔：患者间隔（PI）;诊断间隔（DI）和治疗前间隔（PTI）。对于PI、DI和PTI，使用Wilcoxon秩和检验和Kruskal-Wallis检验对不同特征的中位时间间期进行双变量比较。考克斯比例风险模型被用来确定独立与PI，DI和PTI.Results相关的因素：201名参与者的中位年龄为54岁，22%的晚期疾病。中位TT为110天，中位患者、诊断和治疗前间隔分别为23、28和37天。与PI相关的因素为：年龄较大（风险比（HR）0.59，95% CI 0.40-0.86）、最初症状否认（HR 0.43，95% CI 0.19-0.97）和在寻求治疗前等待肿块增大（HR 0.51，95% CI 0.33-0.77）。有合并症的女性DI显著更长（HR 0.67，95% CI 0.47-0.96），提及否认初始乳房症状的女性也是如此（HR 4.61，95% CI 1.80-11.78）。PTI与就诊时的晚期疾病相关（HR 1.78，95%CI 1.15-2.76）。结论：治疗途径模型为探索患者的护理之旅提供了有用的框架，并确定了有针对性的干预机会。
Background: Typically, women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities. The aim of this study was to determine the pathway that women follow to breast cancer care and factors associated with this journey.Methods: A cross-sectional study was conducted at a tertiary hospital in the Western Cape Province, SA, between May 2015 and May 2016. Newly diagnosed breast cancer patients were interviewed to determine their socio-demographic profile; knowledge of risk factors, signs and symptoms; appraisal of breast changes; clinical profile and; key time events in the journey to care. The Model of Pathways to Treatment Framework underpinned the analysis. The total time (TT) between a woman noticing the first breast change and the date of scheduled treatment was divided into 3 intervals: the patient interval (PI); the diagnostic interval (DI) and the pre-treatment interval (PTI). For the PI, DI and PTI a bivariate comparison of median time intervals by various characteristics was conducted using Wilcoxon rank-sum and Kruskal-Wallis tests. Cox Proportional-Hazards models were used to identify factors independently associated with the PI, DI and PTI.Results: The median age of the 201 participants was 54 years, and 22% presented with late stage disease. The median TT was 110 days, with median patient, diagnostic and pre-treatment intervals of 23, 28 and 37 days respectively. Factors associated with the PI were: older age (Hazard ratio (HR) 0.59, 95% CI 0.40-0.86), initial symptom denial (HR 0.43, 95% CI 0.19-0.97) and waiting for a lump to increase in size before seeking care (HR 0.51, 95% CI 0.33-0.77). Women with co-morbidities had a significantly longer DI (HR 0.67, 95% CI 0.47-0.96) as did women who mentioned denial of initial breast symptoms (HR 4.61, 95% CI 1.80-11.78). The PTI was associated with late stage disease at presentation (HR 1.78, 95% CI 1.15-2.76).Conclusion: The Model of Pathways to Treatment provides a useful framework to explore patient's journeys to care and identified opportunities for targeted interventions.