ABSTRACT

Local malignant potential of basal cell carcinoma (BCC) can lead at advanced stages to the destruction of underlying tissues and significant morbidity. The primary risk factor for progression of advanced basal cell carcinoma (aBCC) is the long duration of the tumour, which results from delay in seeking medical care. To assess the implication of psycho-social factors in the delay before the first medical consultation among patients with aBCC, in order to identify potentially targetable factors enabling earlier diagnosis. Three-step qualitative meta-synthesis: (1) systematic review of the literature; (2) structured qualitative analysis of these documents; (3) construction of a logical model. After screening, 81 articles were included. Self-neglect and denial in patients are roundly put forward as the main obstacles to consultation. We found that avoidance behaviour, mistaken interpretation and banalisation of symptoms, and fear of treatment all played a role. The strongest motivation to seek help comes from the realisation that new symptoms may be dangerous; the role of interpersonal surroundings is highlighted as helpful. Patient delay has multifactorial origins in aBCC, especially self-neglect ranging from denial of tumours to conscious refusal of treatment.

摘要

基底细胞癌 (BCC) 的局部恶性潜能可在晚期导致下层组织的破坏和显着的发病率。晚期基底细胞癌 (aBCC) 进展的主要危险因素是肿瘤持续时间长，这是由于延误就医造成的。评估心理社会因素对 aBCC 患者首次就诊前延迟的影响，以确定能够早期诊断的潜在可靶向因素。三步定性荟萃综合：（1）文献系统回顾；(2) 对这些文件进行结构化的定性分析；(3)逻辑模型的构建。经筛选，共纳入 81 篇文章。患者的自我忽视和否认被全面提出为会诊的主要障碍。我们发现回避行为、对症状的错误解释和平庸化以及对治疗的恐惧都起了一定的作用。寻求帮助的最强烈动机来自于意识到新症状可能是危险的；强调人际关系环境的作用是有帮助的。患者延迟在 aBCC 中具有多种原因，尤其是从否认肿瘤到有意识地拒绝治疗的自我忽视。