Factors influencing early presentation to general practitioners for non–screen detected breast cancer

ABSTRACT

Continued investment in the rural primary care workforce will be key to improving access issues. disparities in cancer outcomes between rural and urban populations remain a global problem.1 Australia is not excepted to such rural-urban inequities.2 For breast cancer, women living in rural New South Wales (NSW) have worse survival rates compared with their urban counterparts.3'4 They are also more likely to have late-stage breast cancer upon diagnosis, longer diagnostic interval and higher risk of death.5-7 Improved cancer control to reduce rural-urban disparities rightly remains an important health priority. Numerous qualitative studies have investigated what influences help-seeking behaviour for such women across various international settings.10-18 A meta-ethnographic synthesis of these studies revealed eight common concepts that affected help-seeking behaviour symptom detection, initial symptom interpretation, symptom monitoring, social interactions, emotional interactions, priority of seeking medical help, appraisal of health services and personal-environmental factors.19 However, these qualitative findings must be interpreted within the contexts that they were conducted in, considering related social and cultural issues for that sample group. The relationship between prolonged breast cancer pathways and poorer survival is well established,22 and identifying factors that prolong the patient interval and determining whether these factors are more common in rural areas could help facilitate the identification of targeted interventions to address the gaps in service delivery and reduce the disparity in breast cancer outcomes for people living in rural Australia. Overview of themes Six key themes emerged from the data analysis, each encompassing a range of facilitators and barriers to help-seeking 1) Initial symptom appraisal;2) symptom monitoring processes;3) emotions and attitudes towards symptoms;4) social interactions;5) personal or environmental factors;and 6) accessing GP services.