Systems Delay in Women with Breast Cancer – Protocol for a Sequential Explanatory Mixed-methods Study from Central Rural India

Abstract

Abstract Context: Globally, breast cancer is the most common malignant tumor, with an incidence of 2 million cases every year and 6 lakh deaths. In India, the incidence rate of breast cancer is 25.8%/100,000 women per year. In developing countries, diagnosis in early stages reduces mortality and morbidity, whereas delay causes reduction in survival rates. Aims: The aim of the study is to assess system delays in patients presenting in surgery Outpatient Department of Tertiary Care Medical College Hospital in rural central India. Settings and Design: A sequential explanatory mixed-methods study will be conducted in two phases at Tertiary Care Medical College Hospital. Subjects and Methods: Estimated sample size is 128 participants, quantitative data will be collected using semistructured questionnaire followed by qualitative component (in-depth interviews) will be conducted. Statistical Analysis to Be Used: Appropriate statistical measures such as Kruskal–Wallis test/analysis of variance test and Chi-square test as per the distribution of quantitative data and thematic content analysis for qualitative date. Results: Of 14 patients, piloted time duration between noticing the abnormality and first visit to health-care facility was >30 days for the majority of participants. Reasons for patients delayed were identified as not troubled by the problem (61.5%). Reasons for diagnosis delay were identified as – was not sure about getting test done (57.1%). Reasons for treatment delay were identified as – was not sure if I wanted to be treated (60%). Conclusions: The findings of study shall help in planning appropriate interventions to reduce morbidity and mortality of breast cancer by addressing the system delays if any.