Women's experiences of making healthcare decisions about their breast cancer: A phenomenological study

Listening to voices from multiple sources: A qualitative text analysis of the emotional experiences of women living with breast cancer in China

Background

Receiving a breast cancer diagnosis and treatment is both a physical and emotional journey. Previous studies using single-source data have revealed common and culture-specific emotional experiences of patients living with breast cancer. However, few studies have combined such data from multiple sources. Thus, using a variety of data sources, the current study sought to explore the emotional experiences of women in China newly diagnosed, post-operative, or undergoing chemotherapy. We posited that even though women living with breast cancer in China have multiple channels through which they can express these emotional experiences, little variance would be found in their emotional expressivity and the themes they want to express due to cultural inhibitions.

Methods

Text data from female patients newly diagnosed, post-operative, or undergoing chemotherapy were collected between June 2021 and January 2022 via a Python web crawler, semi-structured interviews, and an expressive writing intervention. Data were transcribed and subjected to thematic analysis. Reporting followed the consolidated criteria for reporting qualitative studies (COREQ) guidelines.

Results

Analyses were based on 5,675 Weibo posts and comments published by 448 posters and 1,842 commenters, transcription texts from 17 semi-structured interviews, and 150 expressive writing texts. From this total collection of 461,348 Chinese characters, three major themes emerged: (i) conflicting emotions after diagnosis; (ii) long-term suffering and treatment concerns; and (iii) benefit finding and cognitive reappraisal.

Conclusions

Despite gathering information from various sources, we found that distress from body-image disturbances, gender role loss and conflict, and changes in sexuality and fertility, were consistent among this sample of female Chinese patients with breast cancer. However, when women engaged actively in benefit finding and cognitive reappraisal with strong social support, patients were able to find ways to adapt and reported post-traumatic growth. Strong social support was an important facilitator in this growth. These study findings emphasize that healthcare professionals ought to increase cultural sensitivity, provide multiple channels to encourage patients to express their emotions, and incorporate screening for patients' emotional distress at all diagnostic and treatment phases as part of routine nursing care.

"We Want to Sign It, But We Can't Do It": Results From a Qualitative Pilot Study of Experiences Related to Advance Directives Among Families of Older Residents in a Long-term Care Facility

This study aimed to clarify the experiences of family members of older adult residents regarding the signing of an advance directive in the context of a Chinese culture. Twenty family members of older residents in a long-term care facility participated in face-to-face interviews, and the researchers conducted a thematic analysis of observation field notes and interview transcripts. A content analysis of the interviews revealed 4 themes concerning the refusal to sign advance directives: resident decision, group decision, not entitled to decide, and random decision. Health providers may serve as mediators and pass on the residents' views regarding their end-of-life care to their families after holding discussions with residents and their families separately to ensure that an agreeable decision regarding the modes and objectives of EOL care is reached and that such a decision respects the right of the patient to choose.

Concept d'adaptation chez les conjoints de femmes iraniennes atteintes du cancer du sein: étude qualitative basée sur une approche phénoménologique

Introduction

Le cancer du sein provoque une crise multidimensionnelle qui ébranle non seulement la patiente, mais aussi le conjoint et les autres membres de sa famille. Il convient donc d'étudier l'adaptation à ce phénomène, qui constitue l'une des principales difficultés pour les proches. En comprenant mieux comment les conjoints de femmes atteintes d'un cancer du sein font face à cette crise, ces derniers pourraient mieux prendre soin de leurs épouses et améliorer leur qualité de vie.

But de l’étude

L'étude visait à explorer le concept d'adaptation à partir d'expériences vécues par les conjoints de femmes souffrant d'un cancer du sein.

Méthodologie

Cette étude qualitative a été réalisée en 2019 selon une approche phénoménologique dans les villes de Hamadan et Rasht, en Iran. Le groupe de participants comptait 20 conjoints de femmes atteintes du cancer du sein, recrutés grâce à une méthode d'échantillonnage par choix raisonné. Les données ont été recueillies au moyen d'entretiens non structurés en personne; elles ont été analysées à l'aide de la méthode phénoménologique en six étapes de van Manen.

Résultats

Les expériences vécues par les participants ont montré que le phénomène d'adaptation des conjoints au cancer du sein de leur femme se décline en cinq thèmes: souffrance émotionnelle, fardeau des soins, maintien de la cohésion familial, incertitude de l'avenir et sentiment de perte du concept de soi. La compréhension du concept d'adaptation chez les conjoints de femmes atteintes du cancer du sein dans les stratégies de santé peut aider les femmes à bien s'adapter, tout en aidant les professionnels à adopter des mesures efficaces dans le domaine des soins médicaux, pour les patientes et leurs conjoints.

The concept of coping in male spouses of Iranian women with breast cancer: A qualitative study using a phenomenological approach

Introduction

Breast cancer is a multidimensional crisis that affects not just the patient, but the spouse and other family members. Coping with this phenomenon, as one of the important challenges for the families and spouses, requires investigation. Understanding more about how spouses of women with breast cancer cope with this crisis could lead to better performance of spouses in front of their wives and raise their wives' quality of life.

Purpose

The study was conducted to explore the concept of coping based on the lived experiences of spouses of women with breast cancer.

Methods

This qualitative study was conducted with a phenomenological approach in Hamedan and Rasht cities in Iran in 2019. Participants included 20 spouses of women with breast cancer selected by a purposive sampling method. Data were collected through unstructured face-to-face interviews and analyzed using van Manen's six-stage phenomenological method.

Results

The lived experiences of participants showed that the phenomenon of coping in spouses of women with breast cancer included five themes: Emotional pain, Shouldering the burden of care, Striving for family life cohesion, Future in ambiguity, and Sense of loss of self concept. Understanding the concept of coping in the spouses of women with breast cancer in health strategies can help wives achieve effective adaptation and also help professionals take effective measures in the field of medical care for patients and their spouses.

Experiences of accessing and using breast cancer services in Vietnam: a descriptive qualitative study

OBJECTIVES

To understand, describe and analyse the experiences of women with breast cancer in Vietnam when accessing and using breast cancer services.

DESIGN

Descriptive qualitative study. Women were interviewed about their experiences from the first time they became aware of symptoms or changes to their body through treatment and post-treatment. This study is the first descriptive study on breast cancer in Vietnam from the perspective of women with a breast cancer diagnosis.

PARTICIPANTS

Women (n=13) who had completed or were still receiving treatment for breast cancer, purposively recruited from the north and south of Vietnam.

RESULTS

An analysis of the experiences of women with breast cancer in Vietnam revealed a lack of awareness and knowledge about breast cancer and symptoms. Family and social support were described as key factors influencing whether a woman accesses and uses breast cancer services. Cost of treatment and out-of-pocket expenditures limited access to services and resulted in significant financial challenges for women and their families.

CONCLUSIONS

Vietnam has made huge strides in improving cancer care, and is tackling a complex and expanding public health challenge, however, there are a number of areas requiring strengthening and future research. While Vietnam has successfully expanded social health insurance coverage, changes that increase the percentage of costs covered for specific treatments, such as chemotherapy or radiotherapy, could benefit women and their families.

Iranian Cancer Patients Perceptions of Barriers to Participation in Decision-Making: Potential Impact on Patient-Centered Care

Objective:

The purpose of this study was to explore perceptions about barriers to decision-making in Iranian patients with cancer about their care.

Methods:

Utilizing a qualitative approach, semi-structured interviews were conducted with 15 cancer patients.

Results:

Data analysis revealed four central categories reflecting patient perceptions about barriers that included medical dominance (uninformed decision-making, perceived inability to disagree secondary to despair, and patient objectification), healthcare system mistrust (physician, nurse, and medical center facility and equipment), healthcare system characteristics (services and facilities’ limitations, poor communication, healthcare setting compulsion), and cultural barriers (feeling unfamiliar, insecurity in an unfamiliar environment, language barriers, limited attention to religious beliefs).

Conclusions:

Barriers may impact the perceived ability of Iranian patients’ with cancer ability to participate in decision-making regarding their care. Such barriers contain the potential to disrupt patient-centered care. Perceptions about barriers articulated by patients are modifiable. While some Iranian healthcare systems may have problematic challenges, targeted allocation of resources and education of healthcare providers convey strong possibilities to enhance patient-centered care.

Women's stories of living with breast cancer: A systematic review and meta-synthesis of qualitative evidence

RATIONALE

Globally, breast cancer is by far the most frequently occurring cancer amongst women. Whilst the physical consequences of the disease and associated treatments are well documented, a comprehensive picture of how breast cancer is experienced at all stages of disease progression is lacking.

OBJECTIVE

This systematic review aimed to synthesize qualitative studies documenting women's breast cancer narratives into an empirically based explanatory framework.

METHODS

Two investigators independently searched Academic Search Premiere, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycARTICLES, PubMed, Science Direct, SCOPUS, Web of Science and three international dissertation repositories using a pre-specified search strategy to identify qualitative studies on women's breast cancer narratives across all geographic and income-level settings. Of the 7840 studies that were screened for eligibility, included in the review were 180 studies, which were assessed using the Critical Appraisal Skills Programme. Using a 'meta-study' approach, an explanatory model of the breast cancer experience was formulated. Finally, we assessed the confidence in the review findings using the 'Confidence in the Evidence from Reviews of Qualitative Research' (CERQual) guidelines.

RESULTS

Eight core themes were identified: the burden of breast cancer, existential ordeal, illness appraisal, sources of support, being in the healthcare system, the self in relation to others, changes in self-image, and survivor identity. Together, these form the proposed Trajectory of Breast Cancer (TBC) framework.

CONCLUSION

The Trajectory of Breast Cancer explanatory framework offers a theoretically defensible synthesis of women's experiences of breast cancer. This framework provides an empirical basis for future reviewers conducting qualitative and narrative breast cancer research.

Conflicts women with breast cancer face with: A qualitative study

Background and Aim:

The prevalence of cancer in women under 50 years of age has been increased in recent years. Cancer treatment methods can lead to infertility in women with cancer. Fertility and childbearing, as the most important conflicts in the life of women with breast cancer, significantly affect their quality of life.

Materials and Methods:

This research is a qualitative study of content analysis type. Purposeful sampling and semi-structured individual interviews were performed for data collection. The participants were women with breast cancer referred to the Breast Disease Research Center of Shahid Motahari Clinic in Shiraz. The data were saturated after 15 interviews. To assess the validity and reliability, we used the four criteria provided by Lincoln and Guba. The conventional qualitative data analysis and MAXQDA10 software were used to analyze the qualitative data.

Results:

Explaining the conflicts which women with breast cancer are faced has led to the extraction of four main categories: (1) paradox of decision-making to childbearing, (2) fear, (3) sinister emotions, and (4) challenges. The results showed that the paradox of decision-making on childbearing is the most important challenge with which the patients with breast cancer are faced, causing a state of fear, anxiety, and the emergence of sinister emotions in them.

Conclusion:

It seems that paying more attention to preserving reproductive capacity before starting the treatment plays an important role in solving the biggest conflict in the life of breast cancer patients.

Decision-making process related to treatment and management in Korean women with breast cancer: Finding the right individualized healthcare trajectory

BACKGROUND

After being diagnosed with breast cancer, women must make a number of decisions about their treatment and management. When the decision-making process among breast cancer patients is ineffective, it results in harm to their health. Little is known about the decision-making process of breast cancer patients during the entire course of treatment and management.

OBJECTIVES

We investigated women with breast cancer to explore the decision-making processes related to treatment and management.

METHODS

Eleven women participated, all of whom were receiving treatment or management in Korea. The average participant age was 43.5years. For data collection and analysis, a grounded theory methodology was used.

RESULTS

Through constant comparative analyses, a core category emerged that we referred to as "finding the right individualized healthcare trajectory." The decision-making process occurred in four phases: turmoil, exploration, balance, and control. The turmoil phase included weighing the credibility of information and lowering the anxiety level. The exploration phase included assessing the expertise/promptness of medical treatment and evaluating the effectiveness of follow-up management. The balance phase included performing analyses from multiple angles and rediscovering value as a human being. The control phase included constructing an individualized management system and following prescribed and other management options.

CONCLUSIONS

It is important to provide patients with accurate information related to the treatment and management of breast cancer so that they can make effective decisions. Healthcare providers should engage with patients on issues related to their disease, understand the burden placed on patients because of issues related to their sex, and ensure that the patient has a sufficient support system. The results of this study can be used to develop phase-specific, patient-centered, and tailored interventions for breast cancer patients.