Delay in seeking medical care among breast cancer patients with malignant fungating wounds and their caregivers: a qualitative dyadic study.

BACKGROUND

Malignant fungating wounds in breast cancer cause distressing physiological symptoms and profound psychological burdens. Despite the severe and visible nature of malignant fungating wounds, paradoxical care-seeking delays persist, severely impacting patients' quality of life and survival. However, the exact mechanisms underlying this delaying behavior, particularly from a patient-caregiver interactive perspective within a Chinese cultural context remain unexplored. This study aimed to explore the dyadic experiences and decision-making mechanisms of care-seeking delay using the Theory of Planned Behavior (TPB).

METHODS

Based on the Theory of Planned Behavior, data were collected with face-to-face semi-structured interviews from January 2024 to January 2025. Thematic analysis method was used to analysis the data.

RESULTS

Thirteen patient-caregiver dyads were interviewed. Five major themes, strongly aligned with the TPB framework, emerged: (1) Negative attitude and cognitive deficit; (2) The pathway to delay: dyadic behaviors of concealment and dissuasion; (3) Low perceived behavioral control of patient-caregiver dyads; (4) Crisis-triggered transition of medical-seeking intention; and (5) Unspoken support needs of patient-caregiver dyads.

CONCLUSION

The intention to delay care in breast cancer patients with malignant fungating wounds is not isolated but is heavily sculpted by internalized stigma and mutual protective behaviors within the family dyad. To mitigate patient delay, clinical interventions should shift from conventional health education to targeted, family-centered psycho-education that addresses wound-related stigma and empowers caregivers in early symptom identification.