Total Delay for Treatment among Cancer Patients: a Theoryguided Survey in China

Purpose: This study aimed at exploring treatment delay (TD) among cancer patients in China with an attemptto develop a practical methodology facilitating frontline Chinese clinicians in promoting earlier cancer diagnosisand treatment. Materials and
Methods: The study comprised framework development, qualitative interviewsand paired factor rating. Framework development utilized systematic literature review, soft systems thinkingand consensus groups. Qualitative interviews employed a checklist of open questions soliciting informationabout all the domains included the framework from cancer patients drawn via stratified randomized samplingof inpatients at 10 hospitals in Hefei, China. Paired factor rating used a self-developed computer aid and theinterviewed patients as referring cases to weigh the relative importance of the factors listed in the frameworkin terms of their contributions to specific components of total delay (TD).
Results: a) A conceptual frameworkwas proposed consisting of a 6-step path to TD and 36 category determinants. b) A total of 227 patients wereinterviewed; their TD was 267.3 mean or 108 median days ranging from 0 to 2475 days; average appraisal,illness, behavioral, preparation and treatment delay accounted for 52.1%, 9.4%, 0.30%, 8.8% and 29.4% ofthe TD respectively. Individual side factors were rated substantially more important than environmental sidefactors (60% vs. 40%); most influential TD factors included cancer symptoms, overall health, family relationsand knowledge about cancer and health.
Conclusions: The framework proposed together with the interviewingand rating approaches used provide a potential new methodology for understanding cancer patients’ TD andpromoting earlier cancer treatment.