title: Waiting to see the doctor: understanding appraisal and utilization components of consultation delay for new breast symptoms in Chinese women.
abstract: BACKGROUND
  Delayed consultation for potential cancer symptoms influences treatment outcomes and remains problematic. Delay components (Appraisal versus Utilization) and respective associations are poorly understood.
  
  
  METHODS
  Eligible participants were Cantonese-speaking Chinese women, ≥21 years old, with self-discovered breast symptoms, recruited in surgical clinics before their first consultation, and naïve to their diagnosis. Overall 425/433 (98%) women completed a questionnaire on psychosocial, demographic and medical factors, how and when women discovered their breast symptom(s), and their subsequent decision making; 135/425 women (32%) were later diagnosed with breast cancer.
  
  
  RESULTS
  Twenty-two per cent of women delayed >3 months before consultation. Women with breast cancer (28%) more often had prolonged delay than women with benign disease (19%). Attributing symptom to a non-cancerous condition, low fear on symptom discovery, not disclosing symptoms to others, and no prior breast symptom history predicted prolonged (>60 days) Appraisal Delay. Low fear on symptom discovery, seldom thinking about the symptom, and consultation for other reasons predicted prolonged (>14 days) Utilization Delay. Factors predicting Appraisal and Utilization Delays differentiated cancer from non-cancer groups.
  
  
  CONCLUSIONS
  Indecision over symptom meaning comprised the main component of Appraisal and Total Delay, suggesting that educational strategies targeting atypical symptoms should reduce avoidable delays following self-discovered breast symptoms.
authors.affiliation: Centre for Psycho-oncological Research and Training, School of Public Health, The University of Hong Kong, Hong Kong.
authors.forename: Wylie W Y
authors.initials: WW
authors.lastname: Li
authors.forename: Wendy W T
authors.initials: WW
authors.lastname: Lam
authors.forename: Jennifer H F
authors.initials: JH
authors.lastname: Wong
authors.forename: April
authors.initials: A
authors.lastname: Chiu
authors.forename: Miranda
authors.initials: M
authors.lastname: Chan
authors.forename: Amy
authors.initials: A
authors.lastname: Or
authors.forename: Ava
authors.initials: A
authors.lastname: Kwong
authors.forename: Dacita
authors.initials: D
authors.lastname: Suen
authors.forename: Sharon W W
authors.initials: SW
authors.lastname: Chan
authors.forename: Richard
authors.initials: R
authors.lastname: Fielding
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D044466:Asian People; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D002681:China / Q000453:epidemiology; D032882:Comprehension; D057210:Delayed Diagnosis; D005260:Female; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010820:Physicians; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016353:Self-Examination; D012720:Severity of Illness Index; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult