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An Avalanche of Ignoring-A Qualitative Study of Health Care Avoidance in Women With Malignant Breast Cancer Wounds

Lund-Nielsen, Betina MHS; Midtgaard, Julie PhD; Rørth, Mikael MD; Gottrup, Finn MD; Adamsen, Lis PhD

doi: 10.1097/NCC.0b013e3182025020

Background: A contributing factor to development of malignant wounds is patient-related delay caused by health care avoidance.

Objective: The purpose of this study was to describe the experience of health care avoidance in women with advanced breast cancer who have developed malignant wounds.

Methods: A qualitative study was conducted based on semistructured interviews. Seventeen women with advanced breast cancer (median age, 69 years; range, 47-90 years) who had avoided medical treatment despite development of malignant wounds participated. Systematic text-condensation analysis was used.

Results: The women deliberately avoided health care for a median of 24 months (minimum, 3 months; maximum, 84 months). Despite being aware of the development of a malignant wound from a breast lump, the women avoided health care because of negative health care experiences and extremely burdening life situations. The women did not seek health care until their situations became unmanageable. The essence-"an avalanche of ignoring"-is pointing to the escalating, powerful development of destructive feelings behind health care avoidance.

Conclusions: Health care avoidance may be a way of coping both for women who are primary and/or bereaved caregivers. Oncologists and nurses may contribute to the prevention hereof by means of information about the early signs of cancer, benefits of early diagnosis and treatment, and by paying special attention to these women, who may be at high risk for avoidant behaviors.

Implications for Practice: In a preventive perspective, it seems advantageous to bring into focus the health of primary and bereaved caregivers, thereby potentially reducing patient delay and ultimately improving survival.

Author Affiliations: The University Hospitals Centre for Nursing and Care Research (Mrs Lund-Nielsen, Dr Midtgaard, Dr Adamsen); Department of Oncology, Copenhagen University Hospital (Dr Rørth); Department of Dermatology, Wound Healing Centre, Bispebjerg Hospital (Dr Gottrup), Copenhagen, Denmark.

There are no disclaimers.

The study was funded by the Danish Council of Nurses, Novo Nordisk Foundation, Lundbeck Foundation, University Hospital of Copenhagen, Danish Cancer Research Foundation, Danish Wound Society, Einar Willumsens Foundation, Bøghs Foundation, Wedell-Wedellsborgs Foundation, and Inge and Jørgen Larsens Memorial Award.

Correspondence: Betina Lund-Nielsen, MHS, Department 7331, The University Hospitals Centre for Nursing and Care Research, Copenhagen University Hospital, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark (

Accepted for publication October 9, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.