Sexual minority women's interactions with breast cancer providers

Good patient-physician relationships and communication lead to better patient health and more satisfied patients. So far, satisfaction of sexual minority (lesbian, bisexual or women who partner with women) cancer patient-physician interactions is unknown. This study describes sexual minorities' experiences with their treating physicians and which provider attitudes were perceived as positive or negative. We conducted separate individual interviews with 39 sexual minority women diagnosed with breast cancer. All interviews were audio-recorded, transcribed and then analyzed from a Grounded Theory perspective. Participants' narratives indicated that satisfaction is connected with a certain style of patient-physician interactions rather than physician gender. Specific provider traits in the two domains of (1) inter-personal behaviors and (2) medical expertise and decision-making determined patient satisfaction. These findings suggest that physicians of either gender can develop the skills needed to improve quality of breast cancer care for sexual minority women.     

Discussing the effects of prostate cancer beyond biographical disruption and new normalcy: the experiences of men with prostate cancer in Germany

The concept of biographical disruption has been used to explain the experience of a cancer diagnosis. Studies on cancer experience increasingly suggest that people diagnosed in older age may not have such disruptive experiences. Prostate cancer is diagnosed more often in older men and is often considered a disease of old age; furthermore, the signs of illness in prostate cancer and the signs of ageing might become convoluted. With this in mind, this paper aims to explore how 42 men with prostate cancer who participated in an interview study respond to and make sense of bodily changes. The sample was selected using a maximum variation strategy in order to describe a range of possible experiences with prostate cancer. Analysis was conducted thematically. The men’s narratives tell of the constant process of dealing with ageing-related and/or cancer-related changes to both their bodies and their social interactions, and their struggle to disentangle the related effects of ageing and/or cancer on their bodies. We describe how men “muddle through” problems of urinary leakage, potency and loss of libido. We then identify how men attributed changes as part of ageing and/or cancer to (better) manage the experiences of loss.     

Disruption foreclosed: older women's cancer narratives

A challenge has emerged to Bury's (1982) conceptualization of chronic illness as biographical disruption. The idea that certain life circumstances--notably older age or the presence of significant health and social problems--render the experience of chronic illness biographically 'continuous' or 'reinforcing' has gained currency in the social study of chronic illness. This article draws from a qualitative study with women diagnosed with cancer in their 70s or 80s. Respondents' narratives suggest that a long life, especially a life characterized by struggle, does provide a context for the assessment of cancer as non-disruptive. However, the study offers evidence that a long life characterized by sufficiency may also be associated with an assessment of cancer as non-disruptive, and that older age and hardship sometimes render chronic illness especially problematic.Centrally, the article examines respondents' oft-cited commitment to avoid ;dwelling' on illness, highlighting how broad cultural and moral discourses, patterns of social interaction and structures of power combine to foreclose older women's accounts of disruption.     

Family support of immigrant Punjabi women with breast cancer

Women with breast cancer have been found to rely heavily on family members for providing support during their illness experiences. There has been limited research on ethnocultural families' experiences of illness and how these families respond to a diagnosis of breast cancer. This study examined the experiences and responses of family members of immigrant Punjabi women diagnosed with breast cancer. Through interviews with 19 Punjabi women diagnosed with breast cancer and 18 family members, key practical and emotional support strategies were described. Recommendations for culturally appropriate, family-centered models of care are provided that acknowledge breast cancer as a family event.     

Psychosocial responses to treatment for breast cancer among lesbian and heterosexual women

This study compared the experiences of 39 self-identified lesbians and 39 heterosexual women who had recently been treated for breast cancer. They were matched by age, stage of disease, time since diagnosis, and ethnicity. Data were collected by a questionnaire completed at home and returned by mail. Variables assessed included emotional adjustment, thought intrusion and avoidance, perceived quality of life, concerns about breast cancer, benefit finding, relationship and sexual disruption, psychosexual adjustment, social support, and coping. Compared to the heterosexual women, lesbians reported less thought avoidance, lower levels of sexual concern, less concern about their appearance, and less disruption in sexual activity, but also substantially lower perceptions of benefit from having had cancer. Lesbians reported less social connection to family, but no group difference emerged in connection to friends. Lesbians reported less denial coping, and more use of support from friends, more venting, and more positive reframing. Better understanding of the similarities and differences between groups will help address the relevant clinical issues appropriately, in order to optimize psychosocial adjustment to breast cancer. .     

Moral work in women's narratives of breastfeeding

Women's narratives of their breastfeeding experiences are sites of construction and reconstruction of self as they undertake moral work in relation to feeding their baby. We engaged Foucault's ‘technologies of the self’ and his notion of ethics (the relationship with self) to examine that moral work (individual actions rather than adherence to universal moral codes) in relation to women's subjectivity constructed in interviews with 49 women from the UK. Four categories of moral work were identified: biographical preservation, biographical repair, altruism and political action. We describe each of these and conclude that women's embodied experience and sense of self are disciplined within current, limited, often punishing discourses by undertaking painful moral work in order to maintain or repair their subjective positions. We suggest the development of new subject positions around infant feeding practices.     

The emotional journey of women experiencing a breast abnormality

Using grounded theory, a multidisciplinary study team compared the narratives of 30 women who had recently experienced a breast cancer scare. Even though 10 women received a benign diagnosis, all women reported a difficult time prediagnosis, characterized by an array of emotions and contemplation of the meaning of life. Diagnosis separated the two groups with emotional relief dominant for the benign group and intensification of emotions for the cancer group. For those diagnosed with cancer, three factors contributed to arriving at a point of acceptance about the diagnosis and treatment: (a) sustained coping mechanisms; (b) a belief system that shifted the meaning of the cancer experience; and (c) the ability to manage non-cancer-related stressful events. Implications include the need for tailored biopsychosocial treatments that focus on reducing stress, enhancing support systems, reframing beliefs about the illness, and providing the opportunity for the women to talk about their experiences.     

Lumps in the breast: Negotiating risks after a cancer diagnosis

The breast has become a spatial and temporal location for risk. Yet finding a lump in the breast, whether through touch or technology, is a complex process, which involves a variable combination of physical, emotional and cognitive tasks for the woman involved. The lump is both 'self’ and ‘other', in that it is physically positioned within the boundaries of the woman's body, but may be conceptualised as ‘alien'. In addition it is defined as a life-threatening lump through the intervention of expert others, and by the use of technology. Women diagnosed with breast cancer are thus not only faced with a frightening illness, and an entrance into the medical world and all it entails, but also with questions of the sell and its boundaries. In this risky arena, where selfhood and life itself are threatened, women seek ways of managing the experience which will restore them. One way they may do this is through creating a dialogue with the ambiguous entity that is a breast lump. ‘Getting on with it’ becomes an aim which helps the women address issues of selfhood, risk, uncertainty and guilt, and to continue with their lives.     

Men's experiences of giving and taking social support after their wife's spinal cord injury

The aim of this study was to gain an understanding of how men living with women with spinal cord injury (SCI) experienced and acted when they were giving and taking social support to and from their wives and other persons in their social network. Another aim was to give some possible explanations of the complex process of change that they went through. Data were collected through in-depth interviews with four men and field notes. To describe the men's subjective experiences and the process of change, a narrative approach inspired by Polkinghorne was used. The analyses resulted in one story that included the four men's experiences and action. The story showed that when the men went through a process of change, they used and needed both emotional and practical support to handle their new life situation. Furthermore, the men's experiences and action against social support changed over time. This indicated that, through narratives from spouses, professionals within rehabilitation could understand the process of change they went through after their partner's sudden injury, and support them to find strategies to handle their changed life situation. To give some possible explanations for the men's experiences and action during the process of change, the findings are discussed in relation to theories concerning adaptation and coping.     

Native Hawaiian women and the experience of breast cancer

This article describes a qualitative inquiry into the experiences of Native Hawaiian women living through and beyond a diagnosis of breast cancer. Native Hawaiian women have increased incidence and mortality breast cancer rates compared with other ethnic groups in Hawaii. Health promotion programs targeted at Native Hawaiians have often failed because of cultural inappropriateness. A lack of knowledge about the culture is frequently a part of this failure. Therefore, the specific purpose of this study was to examine the lived experience of a selected group of Native Hawaiian breast cancer survivors, uncover the connections between their narratives and their personal and cultural milieux, and generate knowledge about the Native Hawaiian woman's breast cancer experience that would be useful in planning future health promotion outreach efforts. The study consisted of interview data collected from 11 Native Hawaiian female participants, ranging from 44 to 82 years of age. An interpretive phenomenological analysis of the data identified recurrent contexts and themes. The three major contexts in their stories were discovery, transformation (physical, emotional and spiritual), and life realignment. Themes included the importance of spiritual connection, an altruistic desire to reach out and assist others in a similar situation, and a context of familial silence about cancer history. These elements can assist in formulating health promotion and intervention activities for this population. Interwoven with these themes was the Native Hawaiian concept of pono--a sense of rightness and balance, and the crucial importance of the participants' Native Hawaiian identity and cultural heritage.     

Troubling biographical disruption: narratives of unconcern about hepatitis C diagnosis

This paper explores the impact of hepatitis C diagnosis among participants of a recent qualitative study based in New Zealand and Australia. The findings of this research were unique with regard to the small amount of existing literature on the topic. Whilst most social research indicates that diagnosis with hepatitis C is a disruptive or distressing experience, study participants were almost evenly divided between those who reported being distressed by diagnosis and those who described contracting hepatitis C as 'no big deal'. The varied nature of participants' narratives about their hepatitis C diagnosis indicates that the experience of biographical disruption is contextual: dependent upon previous experiences of illness, marginalisation or hardship, and the extent to which hepatitis C is an unknown entity or normalised within community networks. This paper draws on the theoretical frameworks of biographical disruption, normalisation and dys-appearance to illuminate these and other contextual issues informing participants' narratives of unconcern about hepatitis C diagnosis.     

Perceived barriers to self-management in Malaysian women with breast cancer

Naturalistic inquiry using focus group interviews was undertaken to explore experiences and perceived barriers to self management in women with breast cancer. The aim was to identify their perceived barriers to self management to aid the development of rehabilitation programmes. Successful programmes are strongly linked to patients' perceived needs. Four focus groups consisted of 39 women, were purposively recruited. Women's needs within the three areas of medical, emotional and role management of breast cancer were explored. The main barriers were unavailability of information, inability to access services-and-support, and socioeconomic-cultural issues (entrenched myths, low-socioeconomic status, and inadequate insurance-health legislative coverage). The findings provide the critically lacking 'expert-view' of survivors, who verified the importance of the medical, emotional and role management tasks, and highlighted barriers and structural solutions. With breast cancer becoming recognised as a form of chronic illness, this study is timely.     

Reneotiating identity: cancer narratives

We frame the work of living with cancer as one which is identity-altering. Interviews with a heterogeneous group of cancer patients of varying sites and stages were used to conceptualise the identity work as involving disrupted feelings of fit, renegotiating identity, and biographical work. Patient narratives reflect these categories depending on their stage of illness and their experiences in medical institutions.‘Identity work’ is used to describe the process of patients' evaluations of the meaning of their illness within the actual context of ongoing, organised social relationships, including the medical system. We discuss the implications for narrative analyses in the social sciences.     

Association between quality of life and positive coping strategies in breast cancer patients

ABSTRACT

According to the World Health Organization, breast cancer is one of the most prevalent cancers in the Hispanic female population, and it carries a great psychological impact. Acceptance and personal learning derived from the individual’s life experiences and understanding of their emotional state has been suggested as an adaptive profile toward the patient’s perception of the disease. This study aims to explore which psychological variables are related to breast cancer patients’ perception of their quality of life. A cross-sectional, correlational, and non-probabilistic study was performed on 113 women diagnosed with stage 1–3 breast cancer in Mexico and Spain, based on self-reporting through the Mental Adjustment to Cancer Scale, the Positive and Negative Affect Scale, and the EORTC Quality of Life Questionnaire. Recruitment was conducted from March 2015 to April 2018. Through multiple regression analysis, the study found that fighting spirit and positive affect explained 34.2% of quality of life variance F (2, 110) = 30.14, p <.005 of participants. The results support the need to contemplate the importance of positive psychological variables for a multidisciplinary approach to women diagnosed with breast cancer.     

Exploring breast cancer screening barriers among Barbadian women: a focus group study of mammography in a resource-constrained setting

Breast cancer affects women worldwide. Early detection strategies, notably mammography, aim to reduce mortality from breast cancer. However, mammography is a costly screening tool, generates controversy in terms of its impact and adverse effects, and its uptake remains low among some populations. This qualitative study (12 focus groups with 110 participants) explored experiences with mammography among Barbadian women by investigating how barriers are negotiated in a setting of resource-constrained health care provision without a national screening programme. The study findings indicate that, firstly, Barbadian women have to actively seek understanding of both breast cancer and the mammography process. Women described how, with little public awareness and knowledge, they borrow from available public health information on diabetes and HIV/AIDS to give meaning to mammographic screening. Secondly, many women expressed their fear about mammography and its potential consequences, such as experiencing social stigma and losing a romantic relationship after diagnosis. Thirdly, the cost of screening for women who opted for the more reliable private facilities was discussed, along with the potential cost of health care following a diagnosis and the emotional cost of enduring the societal taboo of breast cancer. If breast cancer screening is to be acceptable for this or similar populations, there should be provision of additional services to ensure better access to free screening or alternative strategies, as well as post-diagnostic social and financial support. The policies to develop these services must also address women’s concerns about screening and breast cancer, and provide comprehensive information to allow informed decisions about screening.     

'I wouldn't have been interested in just sitting round a table talking about cancer'; exploring the experiences of women with breast cancer in a group exercise trial

There is evidence that physical activity improves the psychological and physical health of patients with cancer. However, relatively little attention has been paid to understanding their experiences of exercise. This focus group study explored the experiences of women undergoing treatment for breast cancer who had taken part in a supervised group exercise trial. We found that setting up classes solely for women with breast cancer, led by an expert instructor, helped to reduce gender-related barriers to physical activity, such as difficulties in prioritizing exercise over caring roles and worries about changed appearance. For example, some women challenged traditional expectations of femininity by removing their wigs in the classes in order to exercise in comfort. Respondents valued exercising with women in the 'same boat' because of the empathy and acceptance they received and the opportunities to exchange information and form friendships. However, the action-orientated format of the group was preferred to a talk-based format such as a support group; some respondents felt that the 'last thing' they wished to do was to talk about cancer. Our findings therefore challenge stereotypes about women invariably preferring to cope with cancer through emotional disclosure.     

Breast cancer detection behavior among urban women

Data from the ongoing Los Angeles Health Study were analyzed to determine women''s behavior and behavioral intentions regarding three modes of breast cancer detection behavior: breast self-examination (BSE), physician examination of the breasts, and mammography. Two questions were addressed: Are women who engage in one type of breast surveillance behavior likely to engage in all three? What are the social characteristics of women who engage in these breast cancer detection behaviors?The data indicated that women who had had a recent professional (physician) breast examination did not necessarily practice monthly BSE. Only 82 of a sample of 540 women had had mammography; thus, it was not possible to relate this type of surveillance to the other two types. However, 93 percent of the women interviewed indicated they would obtain a mammography examination if their physicians recommended it. There were few differences among the sociodemographic subgroups with respect to BSE and professional examination, with the exception that black women were more likely to report practicing monthly BSE than were white or Hispanic women.