Caring demands and delay in seeking care in African American women newly diagnosed with breast cancer: an ethnographic, photographic study

PURPOSE/OBJECTIVES: To describe the caring behaviors and demands of African American women newly diagnosed with breast cancer and to consider the influence of caring on the women's decision to delay prompt diagnosis and maintain continuing treatment. DESIGN: Focused ethnographic design using photography. SAMPLE/SETTING: 13 African American women (ages 30-66) purposefully selected from two oncology clinics in the mid-South. METHODS: Ethnographic interviews (transcribed verbatim), observations at informant-selected sites, field notes, and snapshots of caring taken by the women where caring occurred were analyzed using Lelninger's phases of ethnographic analysis. FINDINGS: Major themes were (a) generic caring for others and self as meaningful and as promoting continued commitment to diagnosis and treatment, (b) generic and professional caring from others as supportive to the women in "going on," and (c) noncaring related to a "wait and see" attitude of healthcare providers and of women in delaying early diagnosis. CONCLUSIONS: African American women's caring both for and from others was supportive in seeking and continuing diagnosis and treatment. The women with cancer viewed ensuring early diagnosis and continued treatment for other women as their "mission." Delay by providers and women requires further research. IMPLICATIONS FOR NURSING PRACTICE: Nurses must advocate assertiveness for African American women in seeking help for breast cancer symptoms and in challenging providers who adopt a "wait and see" attitude when symptoms are present. Taking snapshots, in addition to fostering the research process, is suggested as a potentially helpful intervention for women as they work through their experiences during treatment for breast cancer.