Breast Cancer Information Behaviours and Needs among Singapore Women: A Qualitative Study

Background: There is growing evidence on cancer communication and its impact on cancer-related health outcomes; however, little is known about how women gain access to and use breast cancer information in the multi-ethnic Asian context. This paper aimed to explore the breast cancer information acquisition behaviours and needs among Singapore women who attended a community-based health organisation for mammography screening. Methods, design and setting: Qualitative data were collected through semi-structured interviews with 37 racially diverse, aged 50 and above women, who have received mammography screening within the past two years. The interviews were conducted at either the Singapore Cancer Society Clinic or participant’s home. Results: Although cancer information scanning was more prevalent than information seeking (91.9% vs. 62.2%), those who purposively seek information exhibited a higher knowledge level of breast cancer. The most commonly cited sources for information scanning were friends, television and family, and for information seeking were the Internet, pamphlets from a healthcare organisation/ public authority, and healthcare providers. Singapore women were well-informed about the benefits of mammogram; however, specific knowledge, such as modifiable risk factors, reasons for different screening options and the trade-off between harm and benefit, was still lacking which led to confusion about screening. Conclusion: Breast cancer health educational materials should provide clear and balanced information to give women a more accurate or realistic expectation about mammography screening. Study findings provide important implications for breast cancer education and programs to move beyond simply raising awareness and craft specific informative messages addressing the needs of the target group.     

Motivational Factors for Breast Cancer Screening Behaviors in Iranian Women: A Qualitative Study

Background: Early diagnosis of breast cancer increases the chance of recovery and life expectancy. Screening is the primary tool for early diagnosis and timely treatment of breast cancer in early stages. This qualitative study aimed to explain the motivational factors for breast cancer screening in Iranian women. Methods: This qualitative study was conducted using content analysis. The 45 women were selected through purposive sampling. Focus group were used for data collection and the data were analyzed using the Lundman and Graneheim thematic content analysis approach.Results: Data analysis identified 9 themes: knowledge acquisition, presence of happy-hopeful spirit, positive attitude and self-worth, maternal role, intellectual and financial independence, religious beliefs, motivational fears, and supportive family. Conclusion: According to the results of this study, it seems that health systems need to change the attitudes and beliefs of people to enhance health culture by identifying women’s motivations for breast cancer screening in different groups and increase social knowledge about screening methods by supporting and training.     

The Decision-Making Journey of Malaysian Women with Early Breast Cancer: A Qualitative Study

Background: The survival outcomes for women presenting with early breast cancer are influenced by treatmentdecisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early,many refuse treatment for complementary therapy. Objective: This study aimed to explore the decision makingexperiences of women with early breast cancer. Materials and Methods: A qualitative study using individualin-depth interviews was conducted to capture the decision making process of women with early breast cancerin Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eightparticipants consented and were interviewed using a semi-structured interview guide. These women were recruitedfrom a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decisionsupport framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribedand analysed using a thematic approach. Results: We identified four phases in the decision-making process ofwomen with early breast cancer: discovery (pre-diagnosis); confirmatory (‘receiving bad news’); deliberation;and decision (making a decision). These phases ranged from when women first discovered abnormalities in theirbreasts to them making final surgical treatment decisions. Information was vital in guiding these women. Supportfrom family members, friends, healthcare professionals as well as survivors also has an influencing role. However,the final say on treatment decision was from themselves. Conclusions: The treatment decision for women withearly breast cancer in Malaysia is a result of information they gather on their decision making journey. Thisjourney starts with diagnosis. The women’s spouses, friends, family members and healthcare professionals playdifferent roles as information providers and supporters at different stages of treatment decisions. However, thefinal treatment decision is influenced mainly by women’s own experiences, knowledge and understanding.     

Physical and Emotional Experiences of Chemotherapy: a Qualitative Study among Women with Breast Cancer in Southern Thailand

Background: Chemotherapy treatment can increase survival rates among women with breast cancer elsewhere.However, it also has negative impact on women’s general appearance, body image and psychological functioning.This study aimed to describe the experiences of chemotherapy treatment among Thai women with breast cancerin rural communities, sounthern Thailand. Methods: Qualitative approach was employed to gain insights aboutthe experiences of the women. In-depth interviewing and drawing methods were conducted with 20 Thai womenwho had been diagnosed with breast cancer. Thematic method was used to analyse the data. Results: Three themesemerged from the findings: I feel so weak: Lack of physical energy; experiencing physical and emotional burdens andmanaging health and life. Women were traumatized by effects of chemotherapy and suffered severe physical side effects.Most received inadequate professional support from health care providers and had to rely on their own judgment anduse local resources to deal with the effects of their treatment and to improve their health and well-being. Conclusions:Chemotherapy brought about traumatic experiences to Thai women with breast cancer. Continual support is needed forthe women to reduce the difficulties they might encounter. Support groups should be established for these women whenreceiving and completing chemotherapy treatment. Our finding suggested that social support programs that meet theirneed are salient means that could reduce the sufferings of these women. Nurses and other health care professionals inthe local community should play their important role to establish such group and make it accessible for all.     

Perception of Breast Cancer Screening among Iranian Women without Experience of Mammography: A Qualitative Study

Background: In Iran, there are high rates of breast cancer. It is among the five most common cancers, thefirst among cancers diagnosed, and is the leading cause of cancer deaths among Iranian women. Objectives: Thepurpose of this qualitative study was to explore perception of breast cancer screening among Iranian women whohave never had a mammograph. Materials and Methods: The current study was part of a qualitative researchconducted by means of content analysis method and purposive sampling of 16 women over the age of 30 yearswho had not undergone mammography using individual semi-structured interviews. Interviews were recordedand transcribed verbatim. The data were under continuous consideration and comparative analysis in order toachieve data saturation. Results: After codification of data, three concept categories were achieved including: i)low awareness, ii) worries, and iii) lack of motivation. Conclusions: Although there is a tendency among Iranianwomen to participate in breast cancer screening, there is a powerful cultural belief that breasts are sexual organsthat should not be discussed publicly. Due to the incidence of breast cancer in Iranian women, it is critical thatbreast awareness education be performed by health care experts to explore the concepts of breast cancer andbreast cancer screening.     

Explaining Perceived Priorities in Women with Breast Cancer: A Qualitative Study

Objective: Cancer is a stressful event in life, and the dreadful impact and problems created for patients and families by cancer negatively affect their quality of life. Therefore, regarding the increasing number of cancer patients and the nature of this disease, the need to recognize and understand the priorities and problems of patients after the diagnosis of cancer is of high importance. This study was designed and implemented with the aim of identifying the perceived priorities of women with breast cancer. Methods: This study is a qualitative research of content analysis type. To collect data, purposeful sampling and deep semi-structured individual interviews were used. The subjects were women with breast cancer who visited the Breast Disease Research Center of Shahid Motahari Clinic in Shiraz, and the data were saturated after 15 interviews. The four criteria presented by Lincken and Guba were used to evaluate the validity and reliability. To analyze the qualitative data, conventional qualitative data analysis and MAXQDA10 software were used. Two themes were obtained in the assessment of interviews and analysis of data: 1) Supportive relief; 2) Therapeutic support. Results: Some of the participants highlighted the role of social and family support in coping with the disease, and considered social communication and continued support in the form of empathic relationship as a turning point in their lives. The absence of a fertility specialist in the cancer treatment system was the main complaint of most participants. The results showed that receiving support from family and the healthcare system is the most important perceived priorities in breast cancer patients. Conclusion: The results of this study show the importance of social support as a perceived priority in breast cancer patients to improve their quality of life. Development and reinforcement of the supportive network seem to be essential to provide the best possible help to these patients.     

Personal and Socio-Cultural Barriers to Cervical Cancer Screening in Iran,Patient and Provider Perceptions: a Qualitative Study

Background: Although cervical cancer is preventable and early screening might decrease the associatedmortality, challenges faced by the women and health care providers can postpone early detection. This qualitativestudy aimed to establish patient and provider perceptions about personal and socio-cultural barriers for cervicalcancer screening in Mashhad, Iran. Materials and Methods: In the present study, which was conducted in 2012,eighteen participants, who were selected purposefully, participated in individual in-depth, semi-structuredinterviews, which were recorded, transcribed verbatim, and analyzed using conventional content analysis andAtlas-Ti software. Results: One theme and two categories were derived from data including: cognitive/behavioralfactors (lack of a community-based approach to cervical cancer, lack of awareness, wrong attitude and lackof health seeking behaviors) and socio/cultural issues (socio-cultural invasion, mismatch between tradition,modernity and religious, extra marital relationships and cultural taboos). Conclusions: Providing communitybased approach education programs and employing social policy are needed for preventing of cervical cancerin Iran.     

Social Support Networks and Depression of Women Suffering from Early-Stage Breast Cancer: A Case Control Study

The aim of this study was to investigate the areas of depression, anxiety, and social support using the structural model of the social network. By comparing the networks of two samples of breast cancer sufferers and healthy control participants, it was possible to identify differences in their relationships, in the shape of the networks themselves, and in the levels of depression and anxiety. Women with breast cancer described smaller and denser networks, including mainly kins whereas the healthy women included more friends, coworkers, and leisure companions. The levels of anxiety and depression were higher in women with breast cancer. Social network and social support measure correlated differently with depression and anxiety in the two groups.     

Understanding Barriers to Malaysian Women with Breast Cancer Seeking Help

Delay in help-seeking behaviour which is potentially preventable has a major effect on the prognosis andsurvival of patients with breast cancer. The objective of this study was to explore reasons for delay in seeking helpamong patients with breast cancer from the East Coast of peninsular Malaysia. A qualitative study using faceto-face in-depth interview was carried out involving 12 breast cancer patients who had been histo-pathologicallyconfirmed and were symptomatic on presentation. Respondents were selected purposely based on their historyof delayed consultation, diagnosis or treatment. All were of Malay ethnicity and the age range was 26-67 years.Three were in stage ll, seven in stage lll and two in stage lV. At the time of interview, all except one respondent hadaccepted treatment. The range of consultation time was 0.2-72.2 months with a median of 1.7 months, diagnosistime was 1.4-95.8 months( median 5.4 months )and treatment time was 0-33.3 months (median 1.2 months). Thethemes derived from the study were poor knowledge or awareness of breast cancer, fear of cancer consequences,beliefs in complementary alternative medicine, sanction by others, other priorities, denial of disease, attitude ofwait and see and health care system weakness. Help-seeking behaviour was influenced by a complex interactionof cognitive, environmental, beliefs, culture and psycho-social factors. Breast cancer awareness and psychologicalcounselling are recommended for all patients with breast symptoms to prevent delay in seeking clinical help.     

Delayed Presentation of Self-discovered Breast Cancer Symptoms in Iranian Women: A Qualitative Study

Background: Delayed presentation of symptomatic breast cancer is a public health issue in Iran, making amajor contribution to low survival. Despite the importance of this problem, current knowledge is insufficient toinform interventions to shorten patient delay. The aim of this study was to explore factors influencing patient delayin Iranian women with self-discovered breast cancer symptom. Materials and Methods: This qualitative studywas conducted during 2012-2013. Purposeful sampling was used to recruit 20 Iranian women with self-discoveredsymptoms of breast cancer who attended the Cancer Institute of Tehran University of Medical Sciences, Tehran,Iran. Data were collected through semi-structured in-depth audiotaped interviews, which were transcribed andanalyzed using conventional content analysis with MAXqda software version 10. Findings: Content analysis of thedata revealed four main themes related to the delay in seeking medical help including: 1) attributing symptomsto the benign conditions; 2) conditional health behavior; 3) inhibiting emotional expression; and 4) barriers toaccess to health care systems. Conclusions: These results suggest that patient delay is influenced by complexand multiple factors. Effective intervention to reduce patient delay for breast cancer should be developed byfocusing on improvement of women’s medical knowledge, managing patients’ emotional expression and reformof the referral system.     

Effect of Group Therapy on Psychological Symptoms and Quality of Life in Turkish Patients with Breast Cancer

Purpose: The aim of this study was to evaluate the effects of the group therapy on psychological symptomsand quality of life of patients with early stage breast cancer. Methods: This study was performed on 16 breastcancer patients who completed treatments. The total group therapy program involved a weekly session of 2-3hours, for 16 weeks. The group therapy sessions were given to women in the oncology department by a clinicalpsychologist and also given training sections by the different professional teams. All the required assessments forthe study were performed after and before 16 week group therapy intervention. Results: Initially we had taken21 women but 16 participated in all therapy programs and submitted questionnaires. The mean age was 47.8years. There were significant differences between before and after group therapy program. Anxiety, depression,and distress showed significant improvements. Hopelessness scale was detected at the border of significance.There was no change in sleep problems and quality of life. According to the analysis of correlation, consideringthe age factor and year of diagnosis, there was found no statistically significant relationship between anxiety,distress, depression, hopelessness, sleeplessness, and quality of life. Conclusions: This pilot study demonstratedthat brief, predominantly group therapy is feasible for patients with breast cancer and, also it may be helpfulto cope with emotional and physical distress     

Perceptions and Opinions towards Skin Cancer Prevention in Malaysia: A Qualitative Approach

Introduction: Malignant melanoma in particular is one of the few remaining cancers with an increasingincidence. Objectives: The objective of this study is to explore the perceptions and opinions of young Malaysianstowards skin cancer prevention. Methodology: Focus group discussions were conducted among 33 medical sciencestudents from Management and Science University (MSU), Shah Alam, Malaysia, using convenience sampling.Students were divided into 4 focus groups consisting of 8, 8, 9 and 8 students respectively. The facilitator wrotedown the conversations and data obtained were classified into various categories and analyzed manually. Results:The majority of the participants mentioned that overexposure to ultraviolet light is the commonest cause ofskin cancer but also that the most benefit we get from sun ight is vitamin D synthesis. The majority mentionedthat the best prevention measure for skin cancer is using a sunscreen, followed by limit exposure to the sun.Conclusion: The present study demonstrated there is a lack of knowledge regarding screening methods andprevention measures of skin cancer. Therefore, there is a need to establish health education unit in all universitiesto educate all university students regarding various health problems including skin cancer prevention.     

Changed Body Image as Perceived by Jordanian Women Undergoing Breast Cancer Treatment

Background: Breast cancer is the most common cancer affecting women worldwide. The purpose of this study wasto generate an understanding of women’s perceptions of changes to their body image due to breast cancer treatment.Method: A phenomenological qualitative approach was taken and semi-structured interviews conducted with 20women who underwent breast cancer treatment at a public hospital in Jordan. Results: Data were analyzed followingColaizzi’s methodology, yielding a core theme (“Broken things cannot be repaired”) and four subthemes: changesin physical wellbeing (“my body fall apart”), changes in emotional wellbeing (“broken heart”), changes in socialwellbeing (“broken future”), and coping strategies (“repairing what has been broken”). Religion and family supportwere major factors helping the women cope with their condition. Conclusion: Nurses and other healthcare providersneed to be aware of body image changes of women with breast cancer to initiate timely, and culturally sensitive nursingintervention and support. Therefore, nurses should support patients in finding their own sources of strength to facilitatetheir healing process.     

Identifying the Social Determinants of Breast Health Behavior: a Qualitative Content Analysis

Background: Prevention, early diagnosis and reduction of mortality caused by breast cancer are the priorities ofthe world health systems. The aim of this study was to identify the social factors that affect the women’s breast healthbehavior based on the social determinants model of the World Health Organization (WHO). Materials and Method:This qualitative study was conducted and analyzed using content analysis approach. The data were collected from32 participants by semi-structured interviews and focused group discussion. The participants comprised of breastsurgeons, radiologists, health care providers and women over 35 years of age in Tehran who were selected throughpurposeful sampling. The interviews continued until data saturation was reached. Results: Based on the experiences ofthe participants, three themes were obtained from the data that shaped the women’s breast health behavior, including1) the context of health policy, 2) socioeconomic status, and 3) cultural, psychological, and behavioral factors.Conclusion: A better understanding of social determinants related to breast health behavior can be effective in designingand applying of appropriate theories and models of education and intervention, so that, by early diagnosis of breastcancer and timely treatment of patients, the disease complications and mortality would be reduced.     

Content of Spiritual Counselling for Cancer Patients Undergoing Chemotherapy in Iran: A Qualitative Content Analysis

Background: Cancer is one of the leading causes of human death. Besides clinical treatment, cancer patients may need emotional and spiritual counselling to overcome their mental and morale problems. Such counselling sessions have been reported influential by many patients. We aimed to explore the structure of spiritual counselling sessions and their content as one of services provided to patients who experience chemotherapy in Iranian hospitals. Methods: Through a qualitative content analysis study, we recorded the discussions between a counsellor, who was a cleric as well, and cancer cases who were undergoing chemotherapy in a hospital in Tehran. The sessions were only recorded if the patient consented to attend at the study. All consideration were taken to avoid release of patients’ identity. The recorded discussions were transcribed verbatim and analyzed thematically after each session, until no new theme was emerged. Result: Twenty two sessions were held. The patients aged 53 years old on average. The content of discussions were analyzed along which 165 codes emerged. Four general themes or phases were recognized through counseling as (i) history-Taking (including demographic, disease-related and spiritual history and characteristics), (ii) general advice, (iii) spiritual-religious advice, and (iv) dealing with patients’ spiritual or religious ambiguities and paradoxes. Conclusion: Counselling of cancer patients needs special and in depth knowledge on spiritual and religious issues. The counsellor should be able to motivate patients, among whom many are disappointed, to follow the curative instructions well and stay hopeful about their treatment and life. Exploring and understanding what happens during a spiritual counselling session can counselling to the conformity and standardization of such interventions.     

Benign Breast Disease as a Breast Cancer Risk in Japanese Women

A hospital-based retrospective cohort study of benign breast disease (BBD) as a risk factor of future breast cancer (BC) development was conducted. Four hundred and twenty-eight patients with biopsied BBD were followed-up for a median period of 8 years, together with age-matched women with normal breasts (normal control) and BC patients (cancer control), at the ratio of 1:2:2. Twenty-one breast cancers developed, 7 in the cases, 4 in the normal controls, and 10 in the BC controls, showing the relative risk (RR) with 95% confidence intervals (CD to be 3.5 (1.03–11.9) in the cases with respect to the normal controls. The RR of the cases is not lower than that of contralateral breast cancer incidence. There were no significant differences in the risks of cancers in other organs among the groups. Pathological examination revealed that only atypical hyperplasia increased the RR of BC, as compared with the normal control breast group, or with non-proliferative disease. These results suggest that in a low-risk country, Japan, BBD is a definite risk factor for BC development as in high-risk countries.