Studying Delays in Breast Cancer Diagnosis and Treatment: Critical Realism as a New Foundation for Inquiry

Jan Angus

Karen-Lee Miller

Tammy Pulfer

Patricia McKeever

ONF 2006, 33(4), E62-E70. DOI: 10.1188/06.ONF.E62-E70

Purpose/Objectives: To examine how delays in breast cancer care currently are conceptualized and to introduce philosophical and theoretical tenets of critical realism as an alternative approach.

Data Sources: Health and social sciences literature.

Data Synthesis: Diagnostic and treatment delays in breast cancer most frequently are conceptualized as patient, provider, or system related. The approach has limited utility in guiding explanatory analysis because it does not acknowledge the social context in which the delays occur. The philosophical tenets of critical realism and two related theoretical approaches are an alternative. They illustrate how an individual's biologic, social, and material resources may undermine or support structural inequities in access to breast cancer care.

Conclusions: Critical realism provides a useful framework for analysis of links between social inequalities and delays in breast cancer diagnosis and treatment.

Implications for Nursing: Access to breast cancer care could be better understood and conceptualized by basing future research and theoretical endeavors on a critical realist perspective.

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