Understanding distress in patients before breast cancer diagnosis in China：A Mixed Methods Study

Abstract Purpose: Although there is extensive research on the link between breast cancer diagnosis and psychological distress after diagnosis, there is limited data on the prevalence of psychological distress prior to breast cancer diagnosis. The purpose of this study is to measure the distress levels of patients before breast cancer diagnosis, to identify the categories of distress they have, and to describe the experience of distress of patients before diagnosis. Methods: This study uses a mixed method of survey and qualitative interviews. In the quantitative part, a cross-sectional survey of 118 patients with completed breast biopsies awaiting pathological diagnosis was conducted using the National Comprehensive Cancer Network's (NCCN's) Distress Thermometer(DT) and Problem List (PL), In the qualitative part, 15 patients were invited using convenient and purposive sampling. Data was collected using a semi-structured face-to-face interview and recorded. The transcribed text was analyzed using Colaizzi's phenomenological method. Results: The results reveal that 63.6% of patients reported a higher level of psychological distress (n=75, scoring≥4).Most patients had emotional (98%) or physical (64%) problems. Among these, worry or anxiety (47.4%), fear (33%), finances (21.1%), sadness and depression(18.6%), and grief or loss(15.2%) were the most frequently reported problems. Multivariate logistic regression analysis showed that the factors associated with psychological distress before the diagnosis of breast cancer patients were age, education level and employment. The experience of patients before diagnosis emerged four themes: Very high psychological distress index; Sources of psychological distress; The demand for information; Positive coping. Conclusions: Psychological distress is prevalent prior to breast cancer diagnosis and may merit early intervention. Gaining insight into patients' emotional distress can assist in shaping future evaluations and interventions focused on their psychosocial needs, to enhance their overall well-being.