Studying delays in breast cancer diagnosis and treatment: critical realism as a new foundation for inquiry.
OBJECTIVE
To examine how delays in breast cancer care currently are conceptualized and to introduce philosophical and theoretical tenets of critical realism as an alternative approach.


METHODS
Health and social sciences literature.


RESULTS
Diagnostic and treatment delays in breast cancer most frequently are conceptualized as patient, provider, or system related. The approach has limited utility in guiding explanatory analysis because it does not acknowledge the social context in which the delays occur. The philosophical tenets of critical realism and two related theoretical approaches are an alternative. They illustrate how an individual's biologic, social, and material resources may undermine or support structural inequities in access to breast cancer care.


CONCLUSIONS
Critical realism provides a useful framework for analysis of links between social inequalities and delays in breast cancer diagnosis and treatment.


CONCLUSIONS
Access to breast cancer care could be better understood and conceptualized by basing future research and theoretical endeavors on a critical realist perspective.
Angus
Jan
J
Faculty of Nursing, University of Toronto, Canada. jan.angus@utoronto.ca
Miller
Karen-Lee
KL
Pulfer
Tammy
T
McKeever
Patricia
P
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility; D006801:Humans; D010684:Philosophy; D010818:Practice Patterns, Physicians'; D012924:Social Conditions; D012959:Socioeconomic Factors; D013997:Time Factors