br The age groups of the seven
The age groups of the seven clinicians were: ≤39 years (5) and ≥40 years (2). Three were females and four males. Their clinical ex-periences in breast cancer and palliative care ranged from 3 to 15 years.
Themes and sub-themes.
Three were certified palliative care specialist (1 nurse and 2 doctors), one was a radiation oncology specialist and the rest were at the rank of senior medical oﬃcers. Table 2 presents the demographical features of the participants. Themes emerged from the data are described below.
All the seven clinicians shared their realities on breast cancer as clinically experienced in relation to: clinical incidence and stage at presentation, and lastly, poor outcomes of the disease and treatment.
2.3. Sub-theme # 1: clinical incidence and stage at presentation
All the seven clinicians agreed that breast cancer was the most oc-curring cancer among women and an average of 5 women diagnosed each week. This is evident in the quotes below:
“It is very common, and I see about 7 advanced breast cancer women at the palliative clinic on Fridays” (Pat).
The age range and stage at presentation was reported at young and late respectively, as illustrated below:
“We are around forty-five and sixty-two (45-62) but typically forties. Advanced or end-stage! That’s why I say it is diﬃcult” (Agyapong). “You rarely see women with early stage breast cancer, most of our pa-
tients will be at advanced stage and Malonyl Coenzyme A as well at the time of
2.4. Sub-theme # 2: poor outcomes of the disease and treatment
Outcomes of the disease and treatment were related to the stage at presentation and it was reported as poor across all the clinicians. A specialist had this to say:
“The aim of treatment is palliation. There are limited options for treat-ment at the stage the patients come, and the outcome is poor though expensive. They often present in a bad state so, they die few weeks to months after diagnosis” (Baba).
Adizah had this to share post 4 years practice in oncology and pal-liative care in the context of breast cancer:
“Because our women come at advanced stage, chance of survival is very slim” All my patients do not survive the disease.
2.5. Theme # 2: barriers to achievement of early detection of breast cancer
This theme describes factors believed to be impediment to the achievement of early detection of the disease within the developing context under study. All the clinicians cited overlapping factors, which were related to the patient and the healthcare system. Two sub-themes identified were: patient-centered barriers and mistrust in the con-temporary healthcare structures.
Number Theme Sub-theme
Theme #1 Breast cancer presentation • Clinical incidence and stage at presentation Poor disease and treatment outcomes
Theme #2 Barriers to achievement of early detection of • The patient-centered barriers Mistrust in the contemporary healthcare structures
breast cancer • Integration of awareness and screening initiatives into palliative care services Develop a model of care Extension
Theme #3 The need for an intervention
of early detection program into the community Advocacy among health professionals
Current position in the hospital
Palliative Surgeon Oncology and Palliative care nurse Radiation Oncologist Palliative Care Specialist Resident in Oncology and palliative Care ﬃSeniorMedicalOcer ﬃSeniorMedicalOcer
Years of practice in palliative care & breast cancer
Directly involve in breast cancer care
Yes Yes Yes Yes Yes
Palliative care team member
Yes Yes Yes Yes Yes
Specialist Nurse specialist
Specialist Specialist Resident Senior MedicalﬃOcer Senior MedicalﬃOcer
Palliative Surgery Oncology and Palliative Radiation Oncology Palliative Palliative Oncology General practitioner General practitioner
MD MD MD MD MD
Ph.D. Fellowship Tertiary Tertiary Tertiary
Male Male Male Female Male
Table 2 fiParticipantsprole. Pseudonyms Age group (Years)
During the interviews, it emerged that early diagnosis of breast cancer begins with symptom discovery and appraisal, which is influ-enced by educational level of women, their awareness and level of knowledge of breast cancer, as well as their risk perception for breast cancer. Limited awareness and knowledge resulting in poor breast cancer symptom recognition were mentioned as barriers to early care seeking.
“A lot of the problem is partly from the women. Due to limited knowledge of the disease, sign and symptom of breast cancer are not seen as im-portant. There is that thing of defining what needs to be sent to the hospital; if it doesn’t incapacitate you, you shouldn’t go to the hospital” (Pat).