{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T17:28:47Z","timestamp":1794504527095,"version":"4.9.1"},"reference-count":33,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,6,27]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This qualitative study aimed to address the following central research question: what are the key factors and behavioural trajectories influencing delayed medical care-seeking among participants with breast cancer-related lymphoedema (BCRL), and how do these factors operate across the stages of symptom perception, alertness and decision-making?<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>This qualitative study employed a phenomenological approach, with semistructured interviews conducted to explore participants' experiences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>A tertiary hospital located in North China.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>18 patients with BCRL were recruited through purposive maximum variation sampling and interviewed in person between January and June 2023.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>10 themes emerged and were categorised into three stages: (1) the perception stage (lack of disease knowledge, risk underestimation and symptom avoidance); (2) the alertness stage (failed self-management, negative coping and exposure to misinformation) and (3) the decision-making stage (financial burden, limited healthcare access, insufficient social support and fatalism). The average delay was 10.2 months, with prolonged delays (&gt;12 months) linked to severe lymphoedema progression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Delayed care seeking in BCRL is a multifactorial behavioural trajectory shaped by knowledge gaps, systemic barriers and psychosocial factors. Clinicians should prioritise early patient education and context-sensitive interventions to mitigate delays.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-086805","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T09:00:20Z","timestamp":1758877220000},"page":"e086805","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Behavioural trajectories of delay in seeking medical care in participants with breast cancer-related lymphoedema: a qualitative study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1410-3065","authenticated-orcid":false,"given":"Min","family":"Li","sequence":"first","affiliation":[{"name":"Nursing Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences,Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, Shanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linying","family":"Wang","sequence":"additional","affiliation":[{"name":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, Shanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Zhang","sequence":"additional","affiliation":[{"name":"Nursing Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences,Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, Shanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3142-493X","authenticated-orcid":false,"given":"Yongxia","family":"Ding","sequence":"additional","affiliation":[{"name":"Shanxi Medical University, Taiyuan, Shanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4712-1727","authenticated-orcid":false,"given":"Pingzhi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, Shanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"2025100512104232000_15.9.e086805.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2025100512104232000_15.9.e086805.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1803290"},{"key":"2025100512104232000_15.9.e086805.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)33326-3"},{"key":"2025100512104232000_15.9.e086805.4","doi-asserted-by":"crossref","first-page":"e555","DOI":"10.1016\/S2214-109X(18)30127-X","article-title":"Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries","volume":"6","author":"Zeng","year":"2018","journal-title":"Lancet Glob Health"},{"key":"2025100512104232000_15.9.e086805.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70076-7"},{"key":"2025100512104232000_15.9.e086805.6","first-page":"755","article-title":"Evidence summary of resistance training for breast cancer-related lymphedema","volume":"56","author":"Liu","year":"2021","journal-title":"Chin J Nurs"},{"key":"2025100512104232000_15.9.e086805.7","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1177\/1054773820958115","article-title":"Lived Experiences for Supportive Care Needs of Women with Breast Cancer-Related Lymphedema: A Phenomenological Study","volume":"30","author":"Arikan D\u00f6nmez","year":"2021","journal-title":"Clin Nurs Res"},{"key":"2025100512104232000_15.9.e086805.8","first-page":"589","article-title":"Subjective symptom interpretation delays lymphedema diagnosis in breast cancer survivors","volume":"15","author":"Smith","year":"2021","journal-title":"J Cancer Surviv"},{"key":"2025100512104232000_15.9.e086805.9","doi-asserted-by":"crossref","DOI":"10.1038\/s41523-021-00276-y","article-title":"The impact of lymphedema on health-related quality of life up to 10 years after breast cancer treatment","volume":"7","author":"J\u00f8rgensen","year":"2021","journal-title":"NPJ Breast Cancer"},{"key":"2025100512104232000_15.9.e086805.10","unstructured":"World Health Organization . 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