br Sub theme advocacy among health professionals br All

2.12. Sub-theme # 4: advocacy among health professionals
All the clinicians acknowledged that provider and health system related factors contribute to delay presentation with breast cancer symptoms. Interesting stories were shared on this theme, however, the main concepts that emerged were lack of meaningful diagnosis facil-ities, knowledge deficit on breast cancer, its diagnostic pathways and management among health professionals as well as unprofessional at-titudes of some health professionals. Therefore, advocacy among health professionals was noted as a key to build their competencies on breast cancer education, counseling, communication, breast examination techniques and referral paths and networks.
“Most often, the women tell us that they visited government health fa-cilities with a small breast lump, but their time was much wasted. The reason is obvious; clinicians’ knowledge deficiencies, unprofessional at-titudes coupled with limited diagnostic facilities. We need education for the health professionals themselves because they do not know about the disease, examination techniques, evaluation measures and treatment. They just go in to remove the lump, no pathology evaluation, put women on analgesics and CP-456773 and then discharge them with no appro-priate referral for timely treatment. Frankly, I am a clinician, but we should acknowledge that the competencies of our colleague clinicians need to be built around breast cancer if early detection can be achieved” (Baba).
3. Discussion
The study explored the experiences and perspectives of clinicians working in a palliative care setting in a tertiary healthcare institution on breast cancer and possible integration of its prevention and early detection of breast cancer in palliative care. Three main themes with sub-themes emerged as presented in the results section. This study revealed an increasing clinical incidence of breast cancer among women in X. For instance, an average of five (5) women diag-nosed of breast cancer per week at the study setting was commonly reported by the study participants. This is a confirmatory findings of prior reports about the increasing incidence of breast cancer in most developing countries including Ghana (International Agency for Research on Cancer & World Health Organization, 2018; Laryea et al., 2014). In addition, the disease was noted by the study participants to occur in young women who commonly present with advanced stage disease due to delayed presentation, a common finding in a previous report (Ohene-Yeboah & Adjei, 2012). This is recognized as a public health concern in developing communities due to its impact on sur-vival, and mortality. Hence, context-specific and cost effectives  International Journal of Africa Nursing Sciences 11 (2019) 100162
measures aimed at promoting early detection to improve survival in this setting is recommended (Zelle et al., 2012).
Patient-related and health system (provider)-related delays were identified as the key accrediting agents for the advanced stage diagnosis commonly observed in the developing context under study. As noted in prior studies (Clegg-Lamptey, Aduful, et al., 2009; Clegg-Lamptey, Dakubo, & Attobra, 2009; Ohene-Yeboah & Adjei, 2012), our findings affirmed the existence of barriers impeding on developing countries’ ability to achieve early detection of breast cancer. Commonly cited barriers by the clinicians in this study were lack of early detection fa-cilities, limited awareness and knowledge of breast cancer, health be-liefs, societal influence, preference for traditional sources of treatment, and unprofessionalism of health providers leading to lack of trust in the modern healthcare structure. Given the absence of a national program for breast cancer prevention and control program in most developing countries including X (Mena et al., 2014), the clinicians in our study recognized the need to address these burdens through integrative clinical initiatives at all levels of prevention. This, coprolites believed, could possibly change the knowledge base, maladaptive attitude and beliefs and the cultural narrative of women around breast cancer and influence future health seeking behaviors of women for breast symptoms. This lend support to the recommendations made by the WHO (World Health Organization, 2007a).