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.     

Indications of change in life perspective among women with breast cancer admitted to complementary care

In this study, qualitative content analysis was used in order to understand the reported changes of life perspective in interviews with 59 women with breast cancer who were admitted to complementary care. The aim of this research was to study women's perceived consequences as well as perceived causes of breast cancer and to explore aspects of importance to the women. The material was collected in semistructured interviews from women with breast cancer at different stages of the disease. The women received complementary care at an anthroposophic clinic in Sweden. Findings showed that these women's view of their relationships with others grew more valuable. Their self-confidence and experience of strength improved, and they regarded life as being more enriched. A change in their disposition towards becoming more fragile and low-spirited was experienced as a hardship by the women. An interesting finding was that the patients described the aetiology of the disease from several interacting perspectives, which also affected their ideas of how to achieve wellbeing and health. The findings support the view that changes of both benefit and harm are present in the experience of breast cancer.     

Coping Strategies and Experiences in Women with a Primary Breast Cancer Diagnosis

Background: Women with breast cancer experience problems in multiple aspects of their lives, but applying effective strategies can result in enhancing their quality of life and their psychosocial adaptation to the disease. However, there is little information about the strategies that women use to cope with complications associated with their experiences following a breast cancer diagnosis. Objectives: The aim of this study was to explore the experience of coping behavior and the main strategies that women use in dealing with a breast cancer diagnosis. Methods: This study was conducted according to a qualitative phenomenological design to investigate women’s experiences in living with breast cancer and the related complications and how they cope with these issues. Purposive sampling was used for recruiting participants with breast cancer, and data collection was conducted by semi-structured, in-depth interviews with 22 patients. The transcribed interviews were analyzed using Van Manen’s thematic approach. Results: The age range of the women was 32-68. Most were married and received adjuvant therapy (i.e., mastectomy surgery and chemo-radiation). Three dominant themes that emerged from the interviews were emotional turmoil, avoidance, and logical efforts. Conclusion: The findings highlight the importance of addressing psycho-oncology intervention programs to address the unmet pyscho-social and palliative care needs of patients suffering from breast cancer.     

The Lived Experience of Australian Women Living with Breast Cancer: A Meta-Synthesis

Background: Breast cancer is the second most common cancer among Australian women. In 2019, an estimated 19,000 women in Australia were diagnosed with breast cancer, with around 3,058 women dying from the disease in the same year. Although many qualitative studies published in Australia exist which examine breast cancer from various perspectives, only limited literature is available which addresses Australian women’s lived experience of breast cancer from diagnosis, treatment and beyond. Method: Meta-synthesis of qualitative studies. Participants who took part in either semi-structured interviews or surveys with open-ended questions were included. A thematic synthesis analysis approach was used. Results: Five themes and 13 sub themes emerged from the data analysis which illustrated the lived experience of Australian women diagnosed with breast cancer. Emotional burden and women’s response towards their breast cancer diagnosis were key themes. Experience of decision- making , social distress, symptoms beyond changes in their body, fertility considerations and their role as mothers were some of the challenges during their treatment. Women coped and adjusted with these challenges through the support of their family, and healthcare providers. Women developed greater empowerment by making their life choices after treatment. Life choices such as getting into a new relationship was challenging for single women. Conclusion: Although most women were emotionally supported following their diagnosis, there are still areas where women could be better supported such as when having to break the news of their breast cancer diagnosis to their children, provision of ongoing emotional support for caregivers of women with breast cancer, providing constant emotional and informational support at the point of diagnosis and during their treatment, tailoring treatments according to different stages of pregnancy, and discussion of fertility treatments in timely manner by healthcare professionals.     

Online interaction. Effects of storytelling in an internet breast cancer support group

The internet provides new ways of forming social relationships among people with breast cancer and is increasingly used for this purpose. This qualitative study, using ethnographic case-study method, aimed to explore how support groups on the internet can break the social isolation that follows cancer and chronic pain, by analysing the storytelling emerging on the Scandinavian Breast Cancer Mailing list. Using participant observation and face-to-face or online interviews of participants, we investigated the motivations of 15 women who chose the internet to counteract social isolation after breast cancer. The results showed that the women were empowered by the exchanges of knowledge and experience within the support group. The internet was considered a means for finding ways of living with breast cancer. Our study suggests that internet support groups have important potential for the rehabilitation of cancer patients.     

Suddenly,a Carriage Appears: Social Support Needs of Latina Breast Cancer Survivors

Through focus groups and individual interviews, data were gathered on the emotional, informational, and instrumental support needs of 22 immigrant Latina women. A thematic analysis revealed that participants who perceived to receive social support reported less psychological distress and better adjustment to breast cancer than those who did not perceive this support. Types and sources of support varied across survivorship stages. Many needs were related to financial, linguistic, and cultural barriers participants encountered in the course of the disease. Based on the findings, we conclude with several clinical recommendations to improve the quality of life in this medically underserved population.     

A pilot study to define social support among Spanish-speaking women diagnosed with a breast abnormality suspicious for cancer: a brief research report

This study explored how Latinas diagnosed with a breast abnormality suspicious for cancer define and use social support while undergoing diagnostic follow-up and/or awaiting a definitive diagnosis. Qualitative data was collected and analyzed from 15 telephone interviews with Spanish-speaking women diagnosed with a breast abnormality suspicious for cancer. Findings indicated that social support was perceived as the comfort, caring, and esteem a person receives from others. With respect to family support, half of the participants felt female family members (e.g., daughters, mothers) were more supportive than male family members (e.g., fathers, sons) when discussing their illness. Many participants felt that asking for help from family members, friends, and health professionals was acceptable under medical circumstances and less justifiable under non-medical circumstances. In conclusion, our findings suggest that Latinas diagnosed with a breast abnormality suspicious for breast cancer are more likely to seek support from family members, friends and health professional after a definitive diagnosis has been given. Additional research is needed to assess the impact of social support in increasing adherence to diagnostic follow-up procedures for a breast abnormality.     

Exploring the multidimensional benefits of breast cancer support groups

Utilizing a more representative sample than previous research, this study examines differences in breast cancer survivors' social, psychological, and physical quality of life by participation in breast cancer support groups. This research also explores whether all breast cancer survivors who participate in breast cancer support groups are benefiting equally. The sample includes 958 women of Eastern North Carolina (26% African American, 73% Caucasian) diagnosed with breast cancer who completed interviews concerning their experience with the disease, as well as their social, psychological, and physical well-being. Support group participation was found to have a significant positive affect on social and overall QOL; yet these affects on social QOL were found to be insignificant, and merely marginally significant concerning overall QOL when controlling for sociodemographics, other social support networks, and disease characteristics. Significant differences were found in the characteristics of participants and non-participants of breast cancer support groups and a number of these differences were found to have significant affects on QOL. These findings suggest that future research needs to investigate the relationships between participation in a breast cancer support group and measures of QOL while controlling for potential confounding factors.     

Social Perceptions of Breast Cancer by Women Still Undergoing or Having Completed Therapy: a Qualitative Study

Background: Diagnosis and treatment of breast cancer is a crisis situation which effects women’s lives physically, socially and spiritually. Investigating women’s perceptions of this disease is crucially important for treatment decisions. We therefore determined social perceptions and interpretations of women diagnosed with breast cancer during therapy and in the post-treatment period. Materials and Methods: In the study, focus group and in-depth interviews were made with women still undergoing or having completed breast cancer treatment. Some 25 women were included in the research. Content analysis was used in the analysis of the qualitative data obtained after the focus group and in-depth interviews. Results: Some of the women demonstrated positive perceptions towards accepting the disease, whereas others had emotions such as rebellion and anger. The loss of a breast is important with different interpretations. Conclusions: Women’s acceptance or rebellion against the disease varies within their social interpretations after the treatment, as at the stage of diagnosis/treatment. All stages of breast cancer negatively affect the social life of the affected individual as much as her body. Nurses assume crucial roles in coping with these negative effects. Thus, it is necessary to know, and sociologically interpret, what is indicated by the information on what the negative effects concerning the disease are and how they are interpreted.     

Experiences of Turkish Women with Breast Cancer During the Treatment Process and Facilitating Coping Factors

Background: Breast cancer is the most common type of cancer among women in Turkey and around theworld. Treatment adversely affects women’s physical, psychological, and social conditions. The purpose of thisstudy was to identify the experiences of Turkish women with breast cancer and the facilitating coping factorswhen they receive chemotherapy. Methods: A phenomenological approach was used to explain the experiencesand facilitating factors of breast cancer patients during the treatment period. Data were collected throughindividual semi-structured interviews. The sample comprised 11 women with breast cancer receiving treatment.Results: At the end of the interviews conducted with women with breast cancer, two main themes were identified:adjustment and facilitating coping factors. The adjustment main theme had two sub-themes: strains and coping.Women with breast cancer suffer physical and psychological strains as well as stress related to social and healthsystems. While coping with these situations, they receive social support, turn to spirituality and make new sensesof their lives. The facilitating coping factors main theme had four sub-themes: social support, disease-relatedfactors, treatment-related factors and relationships with nurses. It has been determined that women receivinggood social support, having undergone preventive breast surgery and/or getting attention and affection fromnurses can cope with breast cancer more easily. Conclusions: Women with breast cancer have difficulty in allareas of their lives in the course of the disease and during the treatment process. Therefore, nurses should provideholistic care, teaching patients how to cope with the new situation and supporting them spiritually. Since familysupport is very important in Turkish culture, patients’ relatives should be informed and supported at every stageof the treatment.     

Exploring the Multidimensional Benefits of Breast Cancer Support Groups

Abstract

Utilizing a more representative sample than previous research, this study examines differences in breast cancer survivors' social, psychological, and physical quality of life by participation in breast cancer support groups. This research also explores whether all breast cancer survivors who participate in breast cancer support groups are benefiting equally. The sample includes 958 women of Eastern North Carolina (26% African American, 73% Caucasian) diagnosed with breast cancer who completed interviews concerning their experience with the disease, as well as their social, psychological, and physical well-being. Support group participation was found to have a significant positive affect on social and overall QOL; yet these affects on social QOL were found to be insignificant, and merely marginally significant concerning overall QOL when controlling for sociodemographics, other social support networks, and disease characteristics. Significant differences were found in the characteristics of participants and non-participants of breast cancer support groups and a number of these differences were found to have significant affects on QOL. These findings suggest that future research needs to investigate the relationships between participation in a breast cancer support group and measures of QOL while controlling for potential confounding factors.     

Psychosocial Stressors,Social Support and Socio-demographic Variables as Determinants of Quality of Life of Turkish Breast Cancer Patients

Purpose: The aim of the present study was to investigate the effects of psychosocial stressors, social supportand socio-demographic variables on quality of life of breast cancer patients. Tools and methods: The study wasconducted between December 2004 and May 2005 and included 101 patients, treated in the Oncology Departmentsof Ege and Pamukkale University Hospitals and Denizli State Hospital. Patients’ demographic data were collectedby questionnaire. The methods used in the interviews were the Rotterdam Symptom Checklist (RSCL), and theMultidimensional Scale of Perceived Social Support (MSPSS), the Karnofsky Performance Status (KPS).Psychosocial stressors were classified according to life events using the DSM-IV multi-axial diagnostic system.Results: It was found that increase of cancer stage triggers a decrease in psychological quality of life (p<0,05);overall global life quality (p<0,001), perceived social support and performance status (p<0,05), all of these beingnegatively affected by family stressors. The patients with increased social support, better psychological andoverall quality of life (p<0,01) and younger age had more physical wellness besides overall quality of life (p<0,05);lower incomes negatively affected overall global life quality (p<0,01) and working at a job decreased thepsychological stressors (p<0,05). Conclusion: From these results, it can be postulated that psychosocial stressors,social support and some socio-demographic variables mostly affected quality of life of the breast cancer patients.     

Living with breast cancer - a challenge to expansive and creative forces

The aim of this qualitative case study is to obtain a deeper and more profound understanding of the life world of women living with breast cancer focusing particularly on changes in life perspective. The study is based on a series of interviews carried out within the space of one year and involving four women with breast cancer; each woman was interviewed four times. The participants were between 42 and 54 years of age; three of the four interviewed were in an advanced stage, with metastasis or recurrent breast cancer. There was an increased awareness of the relationship between life and death, which constituted a disclosure rather than an actual change in life perspective. The four women were 'opening up' to the beauty and the essentials in life and experienced an increased desire to live their life in accordance with their own values. Their revitalised view of life increased their desire for authenticity. When it proved impossible to live in accordance with new insights the women were particularly frustrated. From a caring perspective our findings suggest that an awareness of patients' increased openness to their own needs and desires is an important resource in the healing and rehabilitative process of breast cancer patients. The paradoxes and the struggles involved disguise a hidden potential for health.     

Understanding the breast cancer experience of Asian American women

Breast cancer is the most common form of cancer in women and affects women across all ethnic groups. Although the psychosocial impact of breast cancer is being studied, there is little information on ethnic minorities.To better understand the breast cancer experience of Asian American women, we conducted key informant and focus group interviews. Six professionals participated in the key informant interviews. A total of 34 Asian American breast cancer survivors participated in focus group interviews, including Korean (n=10), Chinese (n=11), and a mixed Asian group (n=13). The common themes identified in this series of qualitative studies included: lack of knowledge about breast cancer; medical care issues such as cost and amount of time spent with physician; cultural factors related to beliefs about illness, gender role and family obligations (e.g. self-sacrifice) and language barriers; the importance of spirituality; and psychosocial concerns related to worry about children, burdening the family, body image and sexual health concerns. A primary source of support and coping for Asian American women with breast cancer was their spiritual beliefs. The results from this qualitative study have been used to prepare a survey instrument to examine these issues in a larger sample of Asian American women.     

Breast cancer survivorship: the role of perceived discrimination and sexual orientation

Breast cancer disproportionately affects sexual minority women (SMW) compared to heterosexual women and a small but growing literature indicates that SMW may have diminished survivorship outcomes; outcomes that are measurably and importantly different from heterosexual breast cancer survivors. However, it remains unknown how sexual orientation influences breast cancer survivorship outcomes such as quality of life. One possible route of influence is SMW’s perceived discrimination in the health care setting. This cross-sectional study examines SMW perceptions of discrimination as one of the multiple facets of the breast cancer survivorship process. This study assessed SMW breast cancer survivor’s perceptions of discrimination during their breast cancer treatment experience and secondarily, examined the role of this perceived discrimination on SMW’s quality of life. Sixty-eight purposefully sampled sexual minority breast cancer survivors completed assessments of quality of life, perceived discrimination, perceived social support and perceived stress via an online survey. Statistical analyses point to perceived discrimination and perceived social support as important indicators for predicting SMW’s quality of life. Future research on SMW’s breast cancer survivorship should include measures of perceived discrimination.     

Experiences of Spouses of Women with Breast Cancer: A Content Analysis

Introduction: In addition to the affected person, diagnosis and treatment of breast cancer also severely affects her husband. Therefore, it is worth paying attention to the needs of husbands of women with breast cancer. Therefore, the aim of the present study was to explain the experiences of spouses of women with breast cancer. Method: The present study was a qualitative study with conventional content analysis approach. Purposive sampling was carried out by selecting 6 spouses of women with breast cancer. Data were collected through semi-structured interview. The recorded interviews were transcribed verbatim. Content analysis was used to reduce and name the data, obtain analytical codes, and finally recognize the theme. Results: Data analysis resulted in the extraction of 4 categories of couples’ mental challenges, multifaceted romantic meditation, multifaceted traumas caused by the disease, dual energies (inductions) of relatives, and 12 subcategories. Conclusion: In spite of suffering from all the challenges and traumas, husbands of women with breast cancer have not left their wives alone and have done their best to improve their lives; so, we can raise ““Scarifying your life to save your wife’s life”” as an extract from the experience of spouses of women with breast cancer. Knowing and understanding this point by clinical staffs and policy makers can provide pave the way for planning to provide comprehensive support to these men.     

A qualitative investigation of breast cancer survivors’ experiences with breastfeeding

Introduction  This is an exploratory, qualitative investigation of breast cancer survivors’ experiences with breastfeeding. Previous studies have focused on the physiology of lactation after surgery and treatment, but have not explored factors influencing breastfeeding decisions and behavior. Methods  We used purposeful sampling to identify 11 breast cancer survivors who had a child after their diagnosis and treatment. Participants were recruited from among those in the Women’s Healthy Eating and Living (WHEL) study and a Young Survival Coalition (YSC) affiliate. We conducted semi-structured, open-ended telephone interviews lasting 45–75 min. We used social cognitive theory (SCT) to structure questions regarding influences on breastfeeding behavior. We transcribed interviews and used cross-case, inductive analysis to identify themes. Results  Ten of 11 participants initiated breastfeeding. The following main themes emerged: 1) Cautiously hopeful, 2) Exhausting to rely on one breast, 3) Motivated despite challenges, 4) Support and lack of support, and 5) Encouraging to others. Discussion/Conclusions  Study participants were highly motivated to breastfeed but faced considerable challenges. Participants described problems that are not unique to women with breast cancer, but experienced these to a much greater degree because they relied mostly or entirely on one lactating breast. This study revealed a need for improved access to information and support and greater sensitivity to the obstacles faced by breast cancer survivors. Implications for cancer survivors  Results of this qualitative analysis indicate that interventions to support the efforts of breast cancer survivors who are interested in breastfeeding are warranted. Additional research would aid in the development of such interventions.