Barriers to seeking diagnosis and treatment for breast cancer in a selected

Philippine population

Victoria M. Medina

Introduction

• Continuation of a previous study– Sample of randomly selected women, 70 women

found positive for breast lump on clinical breast examination (CBE)

– Only 46 women (66%) reported to the referral hospital even when the cost of diagnosis and treatment were shouldered by a third party

– Non-compliers gave perfunctory answers like “I am afraid to know the results”, “it’s not necessary because I don’t feel any pain”, “I do not have time”

Objectives

• To determine the reasons for compliance and non-compliance to diagnosis and treatment in women offered free screening and treatment of breast cancer, after a positive finding on clinical breast examination.

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Methods

Only 58 out of the 70 women positive for breast mass were located and interviewed 38 compliers and 20 non compliers

17 item questionnaire based on the health belief model (HBM) 3 subdomains

Perceived susceptibility Perceived benefits Perceived barriers

A 6-item Likert scale was used for the responses. T-test was used to compare average scores on the Likert scale.

90 % level of significance Logistic regression was done to

determine independent factors affecting outcome.

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Results

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Table 1. Likert Scale Scores For Factors Affecting Compliance Using the Health Belief Model

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ItemsCompliers (n=38)

Mean + SD

Non-compliers (n=20)

Mean + SDP value

Susceptibility 2.62+1.98 3.15+2.32 0.22

Benefit 5.89+0.419 5.85+0.352 0.55

Barriers

Money-related 3.88+2.31 3.77+2.30 0.81

Knowledge (lack of) 2.72+2.13 3.65+2.47 0.05

Fear 2.67+2.19 3.47+2.48 0.09

Time-related 2.25+2.00 2.90+2.39 0.15

Institutional 2.55+1.99 2.50+2.16 0.96

Shame 1.54+1.40 1.75+1.81 0.52

Inconvenient 1.45+1.18 3.00+2.51 0.015

ItemsCompliers (n=38)

Mean + SD

Non-compliers (n=20)

Mean + SD

P value

Number of barriers 3.92+1.12 5.40+1.47 0.00

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Table 2. Comparison of the mean number of barriers identified

Table 3. Results of Logistic Regression, with Compliance as Dependent Variable. Logistic

Regression Table

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Predictor Z p value Odds Ratio 95% CITotal fear -0.57 0.57 0.93 0.74 - 1.18Total info 1.83 0.07 1.23 0.99 - 1.53Inconvenience 1.98 0.05 1.53 1.00 - 2.32Number of barriers 2.50 0.01 2.17 1.18 - 3.97

Discussion• Perceived susceptibility

– Higher score in non-complier

• Perceived benefits– Both compliers and non-compliers agree to the

benefits of early detection and treatment

• Perceived barriers– number of perceived barriers was significantly

fewer among those non-compliers than compliers

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Types of barriers

• Fear– Constant finding in several studies– Abnormal cancer screening findings and recalls for

further investigation have the potential to generate psychological distress

– Individuals who believe that getting cancer will severely limit their ability to function on a daily basis may be fearful of getting screened for cancer

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• Lack of knowledge– add to psychological distress due to the

uncertainty this generates, and can impact negatively on compliance

– some people especially those with high levels of anxiety to start with, may be further distressed with more information about the disease

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• Inconvenience– Echoes the findings of other studies– Weekday clinic schedules only

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Limitations

• Small sample size and its consequence on statistical power

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Conclusions

Non-compliance to referrals may be due to perceived inconvenience, fear and lack of knowledge. Efforts should be made to reinforce breast cancer awareness, and women encouraged to consult for possible cancer related symptoms.

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Thank you

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