Communication About Maternal Breast Cancer With Children: A Qualitative Study

Adolescents' needs for information and psychosocial support during their mother's breast cancer trajectory: A systematic review

OBJECTIVE

Breast cancer is the most common cancer diagnosis among women. The acute crisis and uncertainty that often follow diagnosis put the family at risk of exhaustion and dysfunction. Adolescents have been identified as a particularly vulnerable group of relatives. To investigate how to prevent distress in this group, we systematically reviewed research on adolescents' (11-21 years) needs for information and psycho-social support during their mothers' breast cancer trajectory.

METHOD

Systematic searches were conducted in five bibliometric databases. Peer-reviewed, original research of adolescents aged 11-21 with a mother diagnosed with breast cancer was included. Two researchers conducted screening, quality assessment, and data extraction independently. Thematic synthesis was applied to the included studies.

RESULTS

A total of 8066 studies were screened, and five quantitative and six qualitative studies were included. The results indicated that adolescents' information and psycho-social support needs were poorly met. Many were reluctant to share feelings with family and peers and experienced abandonment during the crisis. Adolescents who were not well informed experienced distress. Poor family functioning increased the level of adolescents' distress.

CONCLUSIONS

Despite limitations regarding heterogeneity among the studies, eligibility criteria, and quality assessment, this review provides clear clinical implications. Encounter groups may support adolescents during their mother's breast cancer trajectory. Furthermore, healthcare professionals could provide more indirect support to adolescents by providing support and clearer guidelines to parents. Finally, adolescents from poor-functioning families need extra attention.

Post-traumatic growth and cancer-related communication among adolescents having mothers with breast cancer

PURPOSE

This study aimed to clarify the characteristics of post-traumatic growth (PTG) among adolescents having mothers diagnosed with breast cancer and the relationship between PTG and cancer-related communication with breast cancer survivors.

METHODS

A cross-sectional study was conducted using anonymous self-report questionnaires with breast cancer survivors and adolescent children. PTG in adolescents was measured using the Japanese version of the revised PTG Inventory for Children (PTGI-C-R-J). Furthermore, hierarchical multiple regression analysis was implemented. To evaluate the impact of cancer-related communication on each subscale, the total score of cancer-related communication was switched with other subscales individually within the constructed model.

RESULTS

A total of 97 breast cancer survivors and their adolescent children were included. The mean scores of the total PTGI-C-R-J and subscale scores for "personal strength," "new possibilities," "relating to others," "appreciation of life," and "spiritual change" were 9.0, 1.7, 1.8, 2.3, 2.4, and 0.9, respectively. The connection between PTG and cancer-related communication was partially clarified. The PTGI-C-R-J score was higher when adolescents shared more information regarding breast cancer with their mothers and lower when adolescents expressed more negative feelings toward their mothers. Communication regarding relationships with mothers was not correlated with PTG.

CONCLUSIONS

Of all PTG domains, "relating to others" and "appreciation of life" were comparatively higher in adolescents. Health professionals should support breast cancer survivors to ensure that they convey appropriate information regarding their treatment plans and side effects to their adolescent children. Health professionals should help adolescent children express their negative feelings calmly and clearly.

Why breast cancer patients avoid communicating disease-related information to their dependent children: A qualitative study

AIM AND OBJECTIVES

This qualitative study explores why breast cancer patients do not share disease-related information with their dependent children.

BACKGROUND

'Open' communication between breast cancer patients and their children is beneficial to both. However, some still try to avoid discussing their diagnosis and related information with their children. Some worries lie in communicating with dependent children, but the underlying cause remains unclear.

DESIGN

Qualitative descriptive study.

METHODS

Semi-structured interview was used in this study. Twenty breast cancer patients with children (aged 8-18 years) were recruited at two urban tertiary hospitals in mainland China. Qualitative content analysis was conducted to analyse and identify themes and subthemes. This study followed the COREQ checklist for qualitative studies.

RESULTS

Three main themes were identified: (1) Uncertainty about the future: Their struggles with cancer remain a sensitive subject with their children. They described the uncertainty surrounding their disease prognosis and their children's response. They were also unsure whether, when and how to inform their children of their conditions; (2) Useless and risky for their children to know the truth: They considered it useless because their children can neither understand nor change the existing facts. They were concerned that it could affect their children's emotional state, character and academic performance; and (3) All for their children's sake: They were willing to take care of their affairs without troubling their dependent children as much as possible.

CONCLUSION

Most mothers delayed communicating disease-related information to their dependent children. However, they often underestimated children's abilities and ignored their thoughts and wishes. Motherhood leads to avoidance and concealment in discussing health issues with their children.

RELEVANCE TO CLINICAL PRACTICE

Mothers should try to understand their children's views towards cancer earlier. Healthcare professionals, especially nurses, should provide further consultation and intervention services to assist mothers and their children.

Communication between mothers with breast cancer and minor children: a qualitative systematic review and meta-synthesis

PURPOSE

Both women with breast cancer and their minor children were affected by a breast cancer diagnosis. The purpose of this review was to synthesize the evidence from qualitative studies on illness-related communication between mothers with breast cancer and their minor children from mothers' perspectives.

METHODS

A thorough systematic review and meta-synthesis of qualitative studies was conducted. English articles published prior to 6 November 2021 were searched from five databases, including PubMed/ MEDLINE, EMBASE, Web of Science, CINAHL, and PsycINFO. After screening the titles, abstracts, and full texts, seven articles were finally included in the quality appraisal and meta-aggregation.

RESULTS

Four synthesized findings were derived from seven articles, including disclosure dilemma, factors impacting disclosure, methods of communication, and information needs.

CONCLUSIONS

This systematic review offered insight into the communication between mothers with breast cancer and their minor children. Various factors influenced the decision-making process on illness-related disclosure, as well as the methods and contents of the communication. Future studies should be undertaken to explore the common model shared by mothers and children who have had comparable experiences, as well as to completely analyze the differences between different cultures in this topic.

Experiences of Adolescent Daughters in Beginning to Live With Their Mothers' Cancer: A Qualitative Study

This study reveals the experiences of adolescent daughters who are beginning to live with their mothers' cancer diagnosis. Participants were 14 adolescent daughters who were either junior or senior high school students when their mothers were diagnosed with breast cancer. We analyzed semi-structured interviews using content analysis. Using interview data, four categories were created from 23 subcategories and 183 codes: (1) using trial and error to attempt to steady their minds against upset and anxiety; (2) minimizing the effect on their own school life and future; (3) moving forward with the help and support of those around them; and (4) advancing together with their family to protect and take care of their mother. As supporters, we must understand adolescent daughters' experiences in living with their mothers' cancer. Open communication with an important outside individual is essential in promoting adolescent daughters' ability to obtain support and live with their mothers' cancer.

“I’m walking on eggshells”: challenges faced by mothers with breast cancer in interacting with adolescent daughters

Background

With breast cancer becoming the most diagnosed cancer in the world, the number of breast cancer-afflicted mothers with adolescent daughters is also rising. Further, adolescent daughters’ mothers serve as role models for in identity formation processes, especially concerning gender and sexuality. Nevertheless, breast cancer threats mother’s health, including such a key symbol of her womanhood—the breast—which may adversely affect the development of an adolescent daughter’s own sense of personal identity and womanhood. However, few researchers and practitioners have paid attention to mother-daughter interactions in the context of breast cancer. Therefore, this study aimed to uncover the nuances of the interactive challenges with adolescent daughters from breast cancer-afflicted mothers’ perspective.

Methods

We conducted a qualitative study following the sample saturation principle, collecting data through semi-structured interviews with 21 breast cancer patients who met the inclusion criteria. We utilized thematic analysis and partially integrated the Foucauldian discourse approach to analyze the data.

Results

Three major themes emerged from the data: (1) mothers are lost in chaos (inability to handle the shock of cancer, feelings of powerlessness about the uncertainty of their life span, and confusion about how to respond to daughter’s curiosity); (2) mothers struggle to maintain balance (torn between protecting daughters and letting them be independent, and making a tough choice between being a mother or a patient); and (3) mothers are immersed in guilt (increasing daughters’ risk of cancer, influencing daughters’ development, and imposing burdens on daughters).

Conclusions

Our research explored the interactive experience of breast cancer-afflicted mothers and adolescent daughters. The insights uncovered by this study will help mothers enhance interaction with their daughters and assist health practitioners in devising interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01872-1.

Experiences of BRCA1/2 Gene Mutation-Positive Women With Cancer in Communicating Genetic Risk to Their Relatives

BACKGROUND

When a woman is diagnosed with hereditary breast or ovarian cancer, family members may be at high risk of cancers associated with BRCA1/2 gene mutation and benefit from disclosure of the genetic test result. This duty of informing relatives may be distressing, or relatives may not be properly informed.

OBJECTIVE

To qualitatively describe breast cancer patients' experiences communicating genetic risk of cancer to their relatives.

METHODS

Probands with BRCA1/2 gene mutations were recruited from an oncology institute in Istanbul, Turkey, and interviewed by telephone. Qualitative content analysis was conducted to derive central elements of the 30 women's experiences communicating genetic risk to their relatives.

RESULTS

Six themes were identified: response to genetic test results, reason for communication, feelings about communication, reflection after communication, results of communication, and needs.

CONCLUSION

Women with cancer found to have BRCA1/2 gene mutations tended to share their genetic test results within the family. The main motives for sharing test results were the desire to encourage relatives to get tested and moral and ethical convictions. Women needed explicit information regarding cancer risk and risk-reducing strategies to act upon.

IMPLICATIONS FOR PRACTICE

The women's feelings and reflections about the communication process were varied and suggest that personalized genetic risk communication interventions may better support women with BRCA1/2 gene mutations during and after communication with relatives. Long-term follow-up of those women is essential because of the need for informed decision on risk-reducing strategies.