Pre-Surgery Healthcare Seeking Among Taiwanese Women With Breast cancer

• Main Authors: Cheng,Hui-Chuan, 鄭慧娟
• Other Authors: Shiu-Yu C.Katie Lee
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/07106133943334005717

碩士 === 國立台北護理學院 === 護理研究所 === 94 === Abstract After a woman detects breast abnormalities, early diagnosis and timely treatment is the key to enhancing cure rate and maintaining life quality. Yet in Taiwan we still lack studies on the process in which females seek medical assistance after they discover breast symptoms and on their life qualities before and after the surgery. Therefore the purpose of this research is to describe breast cancer patients’ healthcare-seeking process, pre-surgery life quality, pre-surgery decisional conflicts and their correlations. This study is a descriptive study. Based on convenient sampling method, it recruits 108 pre-surgery females initially diagnosed with early-stage breast cancer from certain medical center in Taipei City. Research tools are structured survey questionnaires including: healthcare-seeking process and demographic and socio-economic questionnaire, Chinese version of EORTC QLQ-C30 & EORTC QLQ-C-23 life quality scale and Chinese version of Decisional Conflict Scale (DCS). Research findings indicate it takes on average 70.97 days (SD=113.01) for a woman to seek medical attention from the time she detects breast abnormalities. On average there are 13.80 days (SD=16.82) from the doctor-visit day to diagnosis, and 31.06 days (SD=44.03) from the diagnosis day to treatment. Nearly half (44.4%) of the females waited for further observation after they discovered breast problems, but less than 25% would browse the Internet or read books on breast cancer. The time from discovery of breast symptoms to doctor’s visit is significantly correlated with income (χ2=10.34, P=0.03), surgery choices (χ2=8.26, P=0.02) and stage of breast cancer (χ2=15.59, P=0.02). More of those with annual family income of NT$500,000-1,000,000 and stage-3 breast cancer, who to opt for radical mastectomy, wait more than 31 days between the time they discover the symptom and the time they seek medical care. The time from diagnosis to treatment is significantly correlated with age – that of females aged under 40 is significantly greater than 14 days (χ2=10.83, P=0.01). Observation after discovery of breast problems is significantly correlated with annual family annual income (χ2=12.29, P=0.00) and breast cancer stage (χ2=8.31,P=0.04). More females with annual family income of under NT$500,000 and stage-3 breast cancer choose to observe more first. Reading books or reading cancer brochure/booklet (χ2=8.51, P=0.03) and Internet data browsing (χ2=8.51, P=0.03) are significantly correlated with age. The younger they are, the more they are inclined to read books or cancer brochure/booklet and check out data from the Internet. In terms of herbal medicine and breast cancer stage (χ2=11.62, P=0.009), more of the females with cancer stage-3 tend to take herbal medicine. Overall pre-surgery life quality of breast cancer females is medium. The more functional dimension is the role function, which registers lower scores in frequently seen symptoms of cancer. The worst is the emotional function (M=70.45, SD=23.72). Common problems include insomnia and tiredness. EORTC-BR23 breast cancer life quality outcomes indicate the sex life is worse (M=18.06,SD=21.51), body image is good, and symptoms scores are low. The tiredness (F=4.107, P=0.008), body image (F=4.18, P=0.008) and sex life (F=11.071, P=0.000) of pre-surgery life quality show significant discrepancies among breast cancer females of different ages. The degree of tiredness of older patients is lower. Their body image is better while those who are younger have better sex life. The emotional function (F=5.91, P=0.004), sex life (F=4.51, P=0.014) and prospect (F=3.968, P=0.022) of pre-surgery life quality show significant discrepancies among breast cancer females of different marital conditions. Married patients’ emotional function is the worst while their sex life is the best. Married patients have the best prospect, while single patients come in second. Significant discrepancy is present in terms of overall life quality (t=-2.15, P=0.03) among patients of different surgery choices. Those who choose to preserve their breasts have better overall quality of life. Outcomes of this study show the total average score of overall decisional conflict is less than 2.5 indicating the overall decisional conflict of breast cancer females who participate in this study is low. The overall decisional conflict (F=6.39, P=0.001), sense of uncertainty (F=5.00, P=0.003), degree of failure to understand the information (F=5.26, P=0.002), unclear values (F=5.76, P=0.001), supported decision (F=2.86, P=0.04) and decision satisfaction (F=5.46, P=0.002) show significant discrepancies among different age groups. The older they are, the greater their decisional conflict is, the greater their uncertainty, the higher the degree of failure to understand the information, the higher their unclear values, and the lower the degree to which their decisions are supported. The older they are, the worse their decision satisfaction. The overall decisional conflict (F=3.37, P=0.002), sense of uncertainty (F=4.25, P=0.017) and decision satisfaction (F=3.90, P=0.02) show significant discrepancies among different education levels. The lower the education level, the higher the decisional conflict is and the greater the sense of uncertainty. The decision satisfaction of patients of lower education level is worse than that of patients of higher education level. For females for who wait 11-30 days to seek medical attention after detecting breast problems, their overall decisional conflict (F=7.66,P=0.001), sense of uncertainty (F=6.18, P=0.003), degree of failure to understand the information (F=7.56, P=0.001) and unclear values (F=8.45,P=0.001) are all higher. Those who wait less than 10 days have the worst supported decision (F=1.83, P=0.03) and decision satisfaction (F=5.27, P=0.01). For breast cancer females who fail to browse the Internet for information after detecting breast problems, their overall decisional conflict (z =-2.51, P=0.04), sense of uncertainty (z =-3.12, P=0.002), degree of failure to understand the information (z =-2.51, P=0.01) and unclear values (z =-2.62, P=0.009) are higher. Meanwhile, their decision satisfaction (z =-2.85, P=0.004) is worse. Findings of this study indicate in terms of pre-surgery life quality mental and social impacts are greater while pre-surgery decisional conflict tends to be less intense. The issue remains that females have the inclination to delay healthcare seeking after they discover breast abnormalities. Medical practitioners need to look into the issue and provide necessary cares to help breast cancer patients receive timely, effective medical attention they need. The purpose of this study is to help medical practitioners better understand breast cancer patients’ healthcare-seeking process, pre-surgery life quality and pre-surgery decisional conflicts, so they will be able to provide more effective per-surgery cares that these patients need.