skip to main content

Women and Family Members’ Views Regarding Early Decisions about Breast Cancer Treatment: A Qualitative Study

*Wan Hasliza Wan Mamat orcid  -  Kulliyyah of Nursing, International Islamic University Malaysia, Malaysia
Nikki Jarrett  -  Faculty of Science and Health, University of Portsmouth, United Kingdom
Nur Alia Hairulisa@Mohd Hairi  -  Kuantan Medical Centre Pahang, Malaysia
Norfadzilah Ahmad  -  Kulliyyah of Nursing, International Islamic University Malaysia, Malaysia
Ashikin Atan  -  Kulliyyah of Nursing, International Islamic University Malaysia, Malaysia
Susi Lund  -  University of Southampton, United Kingdom
Open Access Copyright (c) 2023 Nurse Media Journal of Nursing
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:
Abstract

Background: Conventional or hospital treatment such as surgery, chemotherapy, or radiotherapy is widely recommended by health care providers for treating breast cancer. Early decision in conventional treatment is a complex phenomenon that requires careful consideration of the medical condition, available information, potential risk, financial, job, and involvement of family members. However, there is an inadequate understanding of early decisions about conventional treatment in Malaysia. 

Purpose: This study aimed to explore the early decisions about breast cancer treatment among women and their family members.

Methods: This study employed a qualitative, narrative approach. Purposive and snowball sampling were applied, and 28 participants were recruited for this study. The participants took part in in-depth, face-to-face, and audio-recorded one-time interviews. All interviews were subsequently transcribed verbatim and analysed using narrative analysis.

Results: This study identified two themes regarding early decisions about breast cancer treatment: (1) women and family members who accepted immediate conventional treatment, and (2) women and family members who refused immediate conventional treatment. This study discovered that some women and family members agreed to undergo conventional treatment immediately due to following doctors’ advice, influence by other patients with breast cancer, personal attitude, and appropriate knowledge concerning breast cancer. Meanwhile, other women refused it due to fear, not ready to undergo treatment, influenced by other people and socio-culture template. The unique finding in this study is the presence of specific socio-cultural templates related to breast cancer.

Conclusion: This study highlights that health care providers can assist women who decline breast cancer treatment by offering education about conventional treatment options. This can be achieved by providing accurate information about the treatment, addressing treatment-related fears, providing emotional support, and encouraging open communication regarding the reasons for refusing conventional treatment.
Fulltext View|Download
Keywords: Breast cancer; decision; family members; treatment; women

Article Metrics:

  1. Al-Bahri, A., Al-Moundhri, M., Al-Mandhari, Z., & Al-Azri, M. (2019). Role of the family in treatment decision-making process for Omani women diagnosed with breast cancer. Patient Education and Counseling, 102(2), 352-359. https://doi.org/10.1016/j.pec.2018.08.026
  2. Almeshar, M., Alzamil, Y., Alyahyawi, A., Abanomy, A., Althmali, O., Al-Enezi, M. S., Shashikumar, C. G., Osman, H., Khandaker, M. U. (2023). Awareness level, knowledge and attitude towards breast cancer among staff and students of Hail University, Saudi Arabia. PLoS One, 18(3), e0282916. https://doi.org/10.1371/journal.pone.0282916
  3. Azizah, A. B., Hashimah, B., Nirmal, K., Siti Zubaidah A. R., Puteri, N.A., Nabihah, A., Sukumaran, R., Balqis, B., Nadia S. M. R., Sharifah, S. S. S, Rohayu, O., Nur Alham, O., & Azlini A. A. (2019). Malaysian National Cancer Registry Report 2012-2016. Ministry of Health Malaysia. https://nci.moh.gov.my/index.php/ms/pengumuman/340-national-cancer-registry-report
  4. Berger, O., Grønberg, B.H., Loge, J.H. (2018). Cancer patients’ knowledge about their disease and treatment before, during and after treatment: A prospective, longitudinal study. BMC Cancer, 18, 381. https://doi.org/10.1186/s12885-018-4164-5
  5. Briley, D. (2007). The effects of culture on decision making and judgement. http://www.ugc.edu.hk/rgc/rgcnews13/west/07.htm]
  6. Chang, N. T., Chang, Y. H., Huang, Y. T., & Chen, S. C. (2021). Factors associated with refusal or discontinuation of treatment in patients with bladder cancer: A cohort population-based study in Taiwan. International Journal of Environmental Research and Public Health, 18(2), 618. https://doi.org/10.3390/ijerph18020618
  7. Citrin, D. L., Bloom, D. L., Grutsch, J. F., Mortensen, S. J., & Lis, C. G. (2012). Beliefs and perceptions of women with newly diagnosed breast cancer who refused conventional treatment in favor of alternative therapies. The Oncologist, 17(5), 607–612. https://doi.org/10.1634/theoncologist.2011-0468
  8. Cypress, B.S. (2017). Rigor or reliability and validity in qualitative research: Perspectives, strategies, reconceptualization, and recommendations. Dimensions of Critical Care Nursing, 36(4), 253-263. https://doi.org/10.1097/DCC.0000000000000253
  9. Dicks, E., Roome, R., Chafe, J., Powell, E., McCrate, F., Simmonds, C,. & Etchegary, H. (2019). Factors influencing surgical treatment decisions for breast cancer: A qualitative exploration of surgeon and patient perspectives. Current Oncology, 26(2), e216-e225. https://doi.org/10.3747/co.26.4305
  10. Engel, S., Jacobsen, H. B., & Reme, S. E. (2023). A cross-sectional study of fear of surgery in female breast cancer patients: Prevalence, severity, and sources, as well as relevant differences among patients experiencing high, moderate, and low fear of surgery. Plos One, 18(6), e0287641. https://doi.org/10.1371/journal.pone.0287641
  11. Farooqui, M., Hassali, M. A., Shatar, A. K. A., Farooqui, M. A., Saleem, F., Haq, N., & Othman, C. N. (2016). Use of complementary and alternative medicines among Malaysian cancer patients: A descriptive study. Journal of Traditional and Complementary Medicine, 6(4), 321-326. https://doi.org/10.1016/j.jtcme.2014.12.008
  12. Ferreira-Padilla, G., Ferrández-Antón, T., Baleriola-Júlvez, J., Braš, M., & Đorđević V. (2015). Communication skills in medicine: Where do we come from and where are we going? Croatian Medical Journal, 56(3), 311-314. https://doi.org/10.3325/cmj.2015.56.311
  13. Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59-82. https://doi.org/10.1177/1525822X05279903
  14. Freedman, R. A., Revette, A. C., Hershman, D. L., Silva, K., Sporn, N. J., Gagne, J. J., Elena, M. K. & Keating, N. L. (2017). Understanding breast cancer knowledge and barriers to treatment adherence: A qualitative study among breast cancer survivors. BioResearch Open Access, 6(1), 159-168. https://doi.org/10.1089/biores.2017.0028
  15. Frenkel, M. (2013). Refusing treatment. Oncologist, 18(5), 634-636. https://doi.org/10.1634/theoncologist.2012-0436
  16. Hajian, S., Mehrabi, E., Simbar, M., & Houshyari, M. (2017). Coping strategies and experiences in women with a primary breast cancer diagnosis. Asian Pacific Journal of Cancer Prevention, 18(1), 215-224. https://doi.org/10.22034%2FAPJCP.2017.18.1.215
  17. Hanna, T. P., King, W. D., Thibodeau, S., Jalink, M., Paulin, G. A., Harvey-Jones, E., O’Sullivan, D. E., Booth, C. M., Sullivan, R. & Aggarwal, A. (2020). BMJ, 371, m4087. https://doi.org/10.1136/bmj.m4087
  18. Joseph, K., Vrouwe, S., Kamruzzaman, A., Balbaid, A., Fenton, D., Berendt, R., Yu, E., & Tai, P. (2012). Outcome analysis of breast cancer patients who declined evidence-based treatment. World Journal of Surgical Oncology, 10, 118. https://doi.org/10.1186/1477-7819-10-118
  19. Jovchelovitch, S., & Bauer, M. W. (2000) Narrative Interviewing. In M. W. Bauer, & G. Gaskell (Eds.), Qualitative researching with text, image and sound: A practical handbook (pp. 57-74). SAGE
  20. Kim, E., Jang, S. H., Andersen, M.R. & Standish, L. J. (2021). “I made all decisions myself”: Breast cancer treatment decision-making by receivers and decliners. Asia Pacific Journal of Oncology Nursing, 8(3), 222-329. https://doi.org/10.4103/apjon.apjon-211
  21. Norsa’adah, B., Rahmah, M. A., Rampal, K. G., & Knight, A. (2012). Understanding barriers to Malaysian women with breast cancer seeking help. Asian Pacific Journal of Cancer Prevention, 13(8), 3723-3730. https://doi.org/10.7314/APJCP.2012.13.8.3723
  22. Pieters, H. C., Heilemann, M. V., Maliski, S., Dornig, K. & Mentes, J. (2012). Instrumental relating and treatment decision making among older women with early stage breast cancer. Oncology Nursing Forum, 39(1), E10-E19. https://doi.org/10.1188/12.ONF.E10-E19
  23. Riessman, C. K. (1990). Divorce talk: Women and men make sense of personal relationship. Rutgers University Press
  24. Riessman, C. K. (1993). Narrative analysis. SAGE
  25. Rocque, G. B., Rasool, A., Williams, B. R., Wallace, A. S., Niranjan, S. J., Halilova, K. I., Turkman, Y. E., Ingram, S. A., Williams, C. P., Forero-Torres, A., Smith, T., Bhatia, S. & Knight, S. J. (2019). What is important when making treatment decisions in metastatic breast cancer? A qualitative analysis of decision-making in patients and oncologists. Oncologist, 24(10),1313-1321. https://doi.org/10.1634/theoncologist.2018-0711
  26. Saeed, S., Asim, M. & Sohail, M. M. (2021). Fears and barriers: Problems in breast cancer diagnosis and treatment in Pakistan. BMC Women’s Health, 21, 151. https://doi.org/10.1186/s12905-021-01293-6
  27. Saita, E., Acquati, C., & Kayser, K. (2015). Coping with early stage breast cancer: Examining the influence of personality traits and interpersonal closeness. Frontiers in Psychology, 6, 88. https://doi.org/10.3389/fpsyg.2015.00088
  28. Singer, S., Blettner, M., Kreienberg, R., Janni, W., Wöckel, A., Kühn, T., Felberbaum, R., Flock, F., & Schwentner L. (2015). Breast cancer patients’ fear of treatment: Results from the multicenter longitudinal study BRENDA II. Breast Care, 10(2), 95-100. http://doi.org/10.1159/000381933
  29. Swainston, K., Campbell, C., van Wersch, A., & Durning, P. (2012). Treatment decision making in breast cancer: A longitudinal exploration of women’s experiences. British Journal of Health Psychology, 17(1), 155-170. https://doi.org/10.1111/j.2044-8287.2011.02028.x
  30. Taib, N. A., Mujar, N. M., Dahlui, M., Emran, N. A., Hadi, I. A., Wai, Y. Y., Arulanantham, S., & Hooi, C. C. (2017). The rate and factors associated with non-adherence to surgery, chemotherapy, radiotherapy and hormonal therapy among breast cancer patients attending public hospitals in Malaysia. Advances in Modern Oncology Research, 3(6), 282
  31. Taib, N. A., Yip, C. H., & Low, W. Y. (2014). A grounded explanation of why women present with advanced breast cancer. World Journal of Surgery, 38, 1676-1684. https://doi.org/10.1007/s00268-013-2339-4
  32. Tariman, J. D., Doorenbos, A., Schepp, K. G., Becker, P. S., & Berry, D. L. (2014). Patient, physician and contextual factors are influential in the treatment decision making of older adults newly diagnosed with symptomatic myeloma. Cancer Treatment Communications, 2(2-3), 34-47. https://doi.org/10.1016/j.ctrc.2014.08.003
  33. Teh, Y. C., Shaari, N. E. N., Taib, N. A., Ng, C. H., See, M. H., Tan, G. H., Jamaris, S., & Yip, C. H. (2014). Determinants of choice of surgery in Asian patients with early breast cancer in a middle income country. Asian Pacific Journal of Cancer Prevention, 15(7), 3163-316. https://doi.org/10.7314/APJCP.2014.15.7.3163
  34. Wang, C. C. & Geale, S. K. (2015). The power of story: Narrative inquiry as a methodology in nursing research. International Journal of Nursing Sciences, 2(2), 195-198. https://doi.org/10.1016/j.ijnss.2015.04.014
  35. Wang, L., Geng, X., Ji, L., Lu, G., & Lu, Q. (2020). Treatment decision-making, family influences, and cultural influences of Chinese breast cancer survivors: A qualitative study using an expressive writing method. Supportive Care in Cancer, 28, 3259-3266. https://doi.org/10.1007/s00520-019-05161-w
  36. WHO. (2021, October). Breast cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancer
  37. Yusuf, A., Ab Hadi, I. S., Mahamood, Z., Ahmad, Z., & Keng, S. L. (2013). Understanding the breast cancer experience: A qualitative study of Malaysian women. Asian Pacific Journal of Cancer Prevention, 14(6), 3689-3698. https://doi.org/10.7314/APJCP.2013.14.6.3689

Last update:

  1. Experiences of Indonesian women with breast cancer underwent treatment decision-making: A qualitative study

    Yenni Ferawati Sitanggang, Hung-Ru Lin. Belitung Nursing Journal, 10 (4), 2024. doi: 10.33546/bnj.3395

Last update: 2024-10-31 17:04:52

No citation recorded.