Understanding breast cancer survivors' information-seeking behaviours and overall experiences: a comparison of themes derived from social media posts and focus groups

Toxic Relationships Described by People With Breast Cancer on Reddit: Topic Modeling Study

BACKGROUND

Social support is essential to promoting optimal health outcomes for women with breast cancer. However, an estimated 12% of women with breast cancer simultaneously experience intimate partner violence (IPV; physical, psychological, or sexual abuse by an intimate partner). Women who experience IPV during breast cancer may lack traditional social support, and thus seek out alternative sources of support. Online community forums, such as Reddit, can provide accessible social connections within breast cancer-specific communities. However, it is largely unknown how women with breast cancer use Reddit to describe and seek support for experiences of IPV.

OBJECTIVE

This study aims to explore how patients with breast cancer describe toxic relationships with their partners and immediate family members on Reddit.

METHODS

This exploratory, cross-sectional, topic-modeling study analyzed textual data from 96 users in the r/breastcancer subreddit in February 2023. The meaning extraction method, inclusive of principal component analysis, was used to identify underlying components. Components were subjected to sentiment analysis and summative content analysis with emergent categorical development to articulate themes.

RESULTS

Seven themes emerged related to toxic relationships: (1) contextualizing storytelling with lymph nodes, (2) toxic behavior and venting emotions, (3) abandonment and abuse following diagnosis, (4) toxic relationships and social-related fears, (5) inner strength and navigating breast cancer over time, (6) assessing social relationships and interactions, and (7) community advice and support. Toxic relationships were commonly characterized by isolation, abandonment, and emotional abuse, which had profound emotional consequences for patients. Reddit facilitated anonymous venting about toxic relationships that helped patients cope with intense feelings and stress. Exchanging advice and support about navigating toxic relationships during breast cancer were core functions of the r/breastcancer community.

CONCLUSIONS

Findings emphasized the value of Reddit as a source of social support for patients with breast cancer experiencing toxic relationships. Clinicians who understand that many patients with breast cancer experience toxic relationships and considerable psychological sequelae are better prepared to support their patients' holistic well-being. Further investigation of Reddit as a possible resource for advice, information, and support has the potential to help inform clinical practice and subsequently, patient health outcomes.

Psychosocial experiences of breast cancer survivors: a meta-review

PURPOSE

Advances in breast cancer care have led to a high rate of survivorship. This meta-review (systematic review of reviews) assesses and synthesises the voluminous qualitative survivorship evidence-base, providing a comprehensive overview of the main themes regarding breast cancer survivorship experiences, and areas requiring further investigation.

METHODS

Sixteen breast cancer reviews identified by a previous mixed cancer survivorship meta-review were included, with additional reviews published between 1998 and 2020, and primary papers published after the last comprehensive systematic review between 2018 and 2020, identified via database searches (MEDLINE, Embase, CINAHL, PsycINFO). Quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and the CASP (Critical Appraisal Skills Programme Qualitative) checklist for primary studies. A meta-ethnographic approach was used to synthesise data.

RESULTS

Of 1673 review titles retrieved, 9 additional reviews were eligible (25 reviews included in total). Additionally, 76 individual papers were eligible from 2273 unique papers. Reviews and studies commonly focused on specific survivorship groups (including those from ethnic minorities, younger/older, or with metastatic/advanced disease), and topics (including return to work). Eight themes emerged: (1) Ongoing impact and search for normalcy, (2) Uncertainty, (3) Identity: Loss and change, (4) Isolation and being misunderstood, (5) Posttraumatic growth, (6) Return to work, (7) Quality of care, and (8) Support needs and coping strategies.

CONCLUSIONS

Breast cancer survivors continue to face challenges and require interventions to address these.

IMPLICATIONS FOR CANCER SURVIVORS

Breast cancer survivors may need to prepare for ongoing psychosocial challenges in survivorship and proactively seek support to overcome these.

Revising Recruitment for Focus Groups to Meet Shifting Needs During COVID-19

BACKGROUND

The COVID-19 pandemic forced researchers to modify recruitment strategies to meet accrual goals for qualitative studies. Traditional methods of in-person recruiting and using paper marketing material were eliminated almost overnight at the onset of the pandemic. Researchers quickly adapted their recruitment strategies, but researchers had to shift local, in-person recruitment efforts to solely using online platforms. The shifting recruitment strategies were accompanied with unexpected challenges, but we were able to meet our accrual goal for focus groups.

OBJECTIVES

The objective of this brief report is to explore new recruitment strategies that developed during the COVID-19 pandemic and offer suggestions for future online-based qualitative studies.

RESULTS

Prior to COVID-19, we designed four main strategies (research registry, marketing material, social media, and provider endorsement) to recruit potential participants for focus groups as part of a qualitative, descriptive study involving young women breast cancer survivors. After the onset of COVID-19, we successfully adapted each of our initial four strategies to recruit potential participants in an incremental process. Using these adapted strategies, a total of 62 young women completed the first part of the data collection process prior to participating in a focus group. Thirty-three women participated in the focus groups, and the remaining 29 participants were lost to follow-up. The vast majority of participants were recruited through marketing material and social media after making strategic changes to recruitment.

DISCUSSION

The most effective method of recruitment was the strategic use of marketing material and social media, and we offer suggestions for researchers considering online recruitment methods. We recommend that researchers use various social media platforms and specific hashtags and target their sample population at the onset of the study. The data collection changes initiated by the effects of COVID-19 may remain, and researchers can consider implementing permanent recruitment strategies to best meet the needs of this new landscape of conducing online focus groups.

Dirty laundry: The nature and substance of seeking relationship help from strangers online

Interpersonal relationships are vital to our well-being. In recent years, it has become increasingly common to seek relationship help through anonymous online platforms. Accordingly, we conducted a large-scale analysis of real-world relationship help-seeking to create a descriptive overview of the nature and substance of online relationship help-seeking. By analyzing the demographic characteristics and language of relationship help-seekers on Reddit (N = 184,631), we establish the first-ever big data analysis of relationship help-seeking and relationship problems in situ among the general population. Our analyses highlight real-world relationship struggles found in the general population, extending beyond past work that is typically limited to counseling/intervention settings. We find that relationship problem estimates from our sample are closer to those found in the general population, providing a more generalized insight into the distribution and prevalence of relationship problems as compared with past work. Further, we find several meaningful associations between relationship help-seeking behavior, gender, and attachment. Notably, numerous gender differences in help-seeking and romantic attachment emerged. Our findings suggest that, contrary to more traditional contexts, men are more likely to seek help with their relationships online, are more expressive of their emotions (e.g., discussing the topic of "heartache"), and show language patterns generally consistent with more secure attachment. Our analyses highlight pathways for further exploration, providing even deeper insights into the timing, lifecycle, and moderating factors that influence who, what, why, and how people seek help for their interpersonal relationships.