Injustice! that is the cause: A qualitative study of the social, economic, and structural determinants of late diagnosis and treatment of breast cancer in Egypt

Joanne McEwan, Carol Underwood, Marilys Corbex

Research output: Contribution to journalArticle

Abstract

Background: In developing countries, breast cancer is generally diagnosed late. Two companion quantitative studies found that health system shortages were a major cause of delayed diagnosis together with poor health literacy. Yet, patients' perceptions regarding the delays were missing. Objective: We conducted a qualitative study to deepen our understanding of women's experiences with diagnosis and treatment delays and highlight nuances not identifiable in the quantitative studies. Interventions/Methods: Fifteen women recruited from the quantitative study were interviewed. Information on diagnosis/treatment delays collected in the quantitative study constituted the basis for the selection of participants, the aim being to ensure a maximum of variability in the types of delays. Results: In addition to women's health literacy challenges, which likely resulted from the interactions of individual, interpersonal, and systemic factors, barriers attributable to healthcare system weaknesses and financial constraints were revealed to be key factors. Conclusions: To reduce late-stage diagnosis, tackling women's "lack of breast cancer awareness" is far from sufficient. Although the majority of health professionals are not in a position to address structural and policy barriers, it is nonetheless important for them to be cognizant of these barriers so that they can better advise and guide their patients. Implications for Practice: Our study aimed to provide a deeper understanding of the social, cultural, and structural barriers patients face in Egypt. Such knowledge should help nurses and other health professionals develop a nonjudgmental, compassionate, and perceptive approach to care.

Original languageEnglish (US)
Pages (from-to)468-475
Number of pages8
JournalCancer Nursing
Volume37
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Egypt
Delayed Diagnosis
Health Literacy
Economics
Breast Neoplasms
Health
Women's Health
Developing Countries
Therapeutics
Nurses
Delivery of Health Care

Keywords

  • Breast cancer
  • Delayed diagnosis
  • Egypt
  • Qualitative research
  • Social determinants
  • Social ecological theory

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)

Cite this

@article{be0e07c4b6ad449a86856603ab189edf,
title = "Injustice! that is the cause: A qualitative study of the social, economic, and structural determinants of late diagnosis and treatment of breast cancer in Egypt",
abstract = "Background: In developing countries, breast cancer is generally diagnosed late. Two companion quantitative studies found that health system shortages were a major cause of delayed diagnosis together with poor health literacy. Yet, patients' perceptions regarding the delays were missing. Objective: We conducted a qualitative study to deepen our understanding of women's experiences with diagnosis and treatment delays and highlight nuances not identifiable in the quantitative studies. Interventions/Methods: Fifteen women recruited from the quantitative study were interviewed. Information on diagnosis/treatment delays collected in the quantitative study constituted the basis for the selection of participants, the aim being to ensure a maximum of variability in the types of delays. Results: In addition to women's health literacy challenges, which likely resulted from the interactions of individual, interpersonal, and systemic factors, barriers attributable to healthcare system weaknesses and financial constraints were revealed to be key factors. Conclusions: To reduce late-stage diagnosis, tackling women's {"}lack of breast cancer awareness{"} is far from sufficient. Although the majority of health professionals are not in a position to address structural and policy barriers, it is nonetheless important for them to be cognizant of these barriers so that they can better advise and guide their patients. Implications for Practice: Our study aimed to provide a deeper understanding of the social, cultural, and structural barriers patients face in Egypt. Such knowledge should help nurses and other health professionals develop a nonjudgmental, compassionate, and perceptive approach to care.",
keywords = "Breast cancer, Delayed diagnosis, Egypt, Qualitative research, Social determinants, Social ecological theory",
author = "Joanne McEwan and Carol Underwood and Marilys Corbex",
year = "2014",
doi = "10.1097/NCC.0000000000000118",
language = "English (US)",
volume = "37",
pages = "468--475",
journal = "Cancer Nursing",
issn = "0162-220X",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Injustice! that is the cause

T2 - A qualitative study of the social, economic, and structural determinants of late diagnosis and treatment of breast cancer in Egypt

AU - McEwan, Joanne

AU - Underwood, Carol

AU - Corbex, Marilys

PY - 2014

Y1 - 2014

N2 - Background: In developing countries, breast cancer is generally diagnosed late. Two companion quantitative studies found that health system shortages were a major cause of delayed diagnosis together with poor health literacy. Yet, patients' perceptions regarding the delays were missing. Objective: We conducted a qualitative study to deepen our understanding of women's experiences with diagnosis and treatment delays and highlight nuances not identifiable in the quantitative studies. Interventions/Methods: Fifteen women recruited from the quantitative study were interviewed. Information on diagnosis/treatment delays collected in the quantitative study constituted the basis for the selection of participants, the aim being to ensure a maximum of variability in the types of delays. Results: In addition to women's health literacy challenges, which likely resulted from the interactions of individual, interpersonal, and systemic factors, barriers attributable to healthcare system weaknesses and financial constraints were revealed to be key factors. Conclusions: To reduce late-stage diagnosis, tackling women's "lack of breast cancer awareness" is far from sufficient. Although the majority of health professionals are not in a position to address structural and policy barriers, it is nonetheless important for them to be cognizant of these barriers so that they can better advise and guide their patients. Implications for Practice: Our study aimed to provide a deeper understanding of the social, cultural, and structural barriers patients face in Egypt. Such knowledge should help nurses and other health professionals develop a nonjudgmental, compassionate, and perceptive approach to care.

AB - Background: In developing countries, breast cancer is generally diagnosed late. Two companion quantitative studies found that health system shortages were a major cause of delayed diagnosis together with poor health literacy. Yet, patients' perceptions regarding the delays were missing. Objective: We conducted a qualitative study to deepen our understanding of women's experiences with diagnosis and treatment delays and highlight nuances not identifiable in the quantitative studies. Interventions/Methods: Fifteen women recruited from the quantitative study were interviewed. Information on diagnosis/treatment delays collected in the quantitative study constituted the basis for the selection of participants, the aim being to ensure a maximum of variability in the types of delays. Results: In addition to women's health literacy challenges, which likely resulted from the interactions of individual, interpersonal, and systemic factors, barriers attributable to healthcare system weaknesses and financial constraints were revealed to be key factors. Conclusions: To reduce late-stage diagnosis, tackling women's "lack of breast cancer awareness" is far from sufficient. Although the majority of health professionals are not in a position to address structural and policy barriers, it is nonetheless important for them to be cognizant of these barriers so that they can better advise and guide their patients. Implications for Practice: Our study aimed to provide a deeper understanding of the social, cultural, and structural barriers patients face in Egypt. Such knowledge should help nurses and other health professionals develop a nonjudgmental, compassionate, and perceptive approach to care.

KW - Breast cancer

KW - Delayed diagnosis

KW - Egypt

KW - Qualitative research

KW - Social determinants

KW - Social ecological theory

UR - http://www.scopus.com/inward/record.url?scp=84927794959&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84927794959&partnerID=8YFLogxK

U2 - 10.1097/NCC.0000000000000118

DO - 10.1097/NCC.0000000000000118

M3 - Article

C2 - 24406381

AN - SCOPUS:84927794959

VL - 37

SP - 468

EP - 475

JO - Cancer Nursing

JF - Cancer Nursing

SN - 0162-220X

IS - 6

ER -