DOI QR코드

DOI QR Code

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

  • Abdullah, Adina (Department of Primary Care Medicine, University of Malaya) ;
  • Abdullah, Khatijah Lim (Department of Nursing Sciences, Faculty of Medicine, University of Malaya) ;
  • Yip, Cheng Har (Department of Surgery, Faculty of Medicine, University of Malaya) ;
  • Teo, Soo-Hwang (Department of Surgery, Faculty of Medicine, University of Malaya) ;
  • Taib, Nur Aishah (Department of Surgery, Faculty of Medicine, University of Malaya) ;
  • Ng, Chirk Jenn (Department of Primary Care Medicine, University of Malaya)
  • Published : 2013.12.31

Abstract

Background: The survival outcomes for women presenting with early breast cancer are influenced by treatment decisions. 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 making experiences of women with early breast cancer. Materials and Methods: A qualitative study using individual in-depth interviews was conducted to capture the decision making process of women with early breast cancer in Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eight participants consented and were interviewed using a semi-structured interview guide. These women were recruited from a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decision support framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribed and analysed using a thematic approach. Results: We identified four phases in the decision-making process of women 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 their breasts to them making final surgical treatment decisions. Information was vital in guiding these women. Support from 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 with early breast cancer in Malaysia is a result of information they gather on their decision making journey. This journey starts with diagnosis. The women's spouses, friends, family members and healthcare professionals play different roles as information providers and supporters at different stages of treatment decisions. However, the final treatment decision is influenced mainly by women's own experiences, knowledge and understanding.

References

  1. Fallowfield LJ, Hall A, Maguire P, Baum M, A'Hern RP (1994). Psychological effects of being offered choice of surgery for breast cancer. BMJ, 309, 448. https://doi.org/10.1136/bmj.309.6952.448
  2. Ford S, Schofield T, Hope T (2002). Barriers to the evidencebased patient choice (EBPC) consultation. Patient Educ Couns, 47, 179-85. https://doi.org/10.1016/S0738-3991(01)00198-7
  3. Hack TF, Degner LF, Watson P, Sinha L (2006). Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer. Psycho-Oncol, 15, 9-19. https://doi.org/10.1002/pon.907
  4. Hasan SS, Ahmed SI, Bukhari NI, Loon WCW (2009). Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics. Complement Ther Clin Pract, 15, 152-7. https://doi.org/10.1016/j.ctcp.2009.02.003
  5. Butow PN, Maclean M, Dunn SM, Tattersall MHN, Boyer MJ (1997). The dynamics of change: Cancer patients' preferences for information, involvement and support. Ann Oncol, 8, 857-63. https://doi.org/10.1023/A:1008284006045
  6. Coulter A, Jenkinson C (2005). European patients' views on the responsiveness of health systems and healthcare providers. Eur J Pub Hlth, 15, 355-60. https://doi.org/10.1093/eurpub/cki004
  7. Henman MJ, Butow PN, Brown RF, Boyle F, Tattersall MHN (2002). Lay constructions of decision-making in cancer. Psycho-Oncol, 11, 295-306. https://doi.org/10.1002/pon.566
  8. Ibrahim NI, Dahlui M, Aina EN, Al-Sadat N (2012). Who are the breast cancer survivors in Malaysia? Asian Pac J Cancer Prev, 13, 2213-8. https://doi.org/10.7314/APJCP.2012.13.5.2213
  9. The Lancet (2009). Breast cancer in developing countries. The Lancet, 374, 9701, 1567.
  10. Mazanah M, Sharan M, Norhasmilia S (2012). Why Breast Cancer Patients Seek Traditional Healers. Int J Breast Cancer, 2012, 689168
  11. McWilliam CL, Brown JB, Stewart M (2000). Breast cancer patients' experiences of patient–doctor communication: a working relationship. Patient Educ Couns, 39, 191-204. https://doi.org/10.1016/S0738-3991(99)00040-3
  12. Mills ME, Sullivan K (1999). The importance of information giving for patients newly diagnosed with cancer: a review of the literature. J Clin Nurs, 8, 631-42. https://doi.org/10.1046/j.1365-2702.1999.00296.x
  13. Morris J, Royle GT (1988). Offering patients a choice of surgery for early breast cancer: A reduction in anxiety and depression in patients and their husbands. Soc Sci Med, 26, 583-5. https://doi.org/10.1016/0277-9536(88)90021-4
  14. Nakashima M, Kuroki S, Shinkoda H, et al (2012). Informationseeking experiences and decision-making roles of Japanese women with breast cancer. Fukuoka Igaku Zasshi, 103, 120-30.
  15. Pope C, Mays N (1995). Qualitative Research: Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ, 311, 42-5. https://doi.org/10.1136/bmj.311.6996.42
  16. Porter P (2008). “Westernizing” Women's Risks? Breast Cancer in Lower-Income Countries. N Engl J Med, 358, 213-6. https://doi.org/10.1056/NEJMp0708307
  17. Richards L, Morse JM (2002). Readme first for a user's guide to qualitative methods. Thousand Oaks, London, New Delhi: Sage
  18. Rutten LJ, Arora NK, Bakos AD, Aziz N, Rowland J (2005). Information needs and sources of information among cancer patients: a sytematic review of research. Patient Educ Couns, 57, 250-61. https://doi.org/10.1016/j.pec.2004.06.006
  19. Taib NA, Yip CH, Ibrahim M, Ng CJ, Farizah H (2007). Breast cancer in Malaysia: Are our women getting the right message? 10 Year-Experience in a single institution In Malaysia. Asian Pac J Cancer Prev, 8, 141-5.
  20. Taib NA, Yip CH, Mohamed I (2008). Survival analysis of Malaysian women with breast cancer: Results from The University of Malaya Medical Centre. Asian Pac J Cancer Prev, 9, 197-202.
  21. Taib NA, Akmal M, Mohamed I, Yip CH (2011). Improvement in survival of breast cancer patients-trends over two time periods in a single institution in an Asia Pacific country, Malaysia. Asian Pac J Cancer Prev, 12, 345-9.
  22. Thibodeau J and MacRae J (1997). Breast cancer survival: A phenomenological inquiry. ANS Adv Nurs Sci, 19, 65-74. https://doi.org/10.1097/00012272-199706000-00006
  23. Yip CH, Cazap E, Anderson BO, et al (2011). Breast cancer management in middle-resource countries (MRCs): Consensus statement from the Breast Health Global Initiative. Breast, 20, 12-9.

Cited by

  1. Comparison of Quality of Life of Turkish Breast Cancer Patients Receiving Breast Conserving Surgery or Modified Radical Mastectomy vol.15, pp.13, 2014, https://doi.org/10.7314/APJCP.2014.15.13.5377
  2. Determinants of Choice of Surgery in Asian Patients with Early Breast Cancer in A Middle Income Country vol.15, pp.7, 2014, https://doi.org/10.7314/APJCP.2014.15.7.3163
  3. Un-met Supportive Care Needs of Iranian Breast Cancer Patients vol.15, pp.9, 2014, https://doi.org/10.7314/APJCP.2014.15.9.3933
  4. Evaluation of Factors Impacting Cosmetic Outcome of Breast Conservative Surgery - a Study in Iran vol.16, pp.6, 2015, https://doi.org/10.7314/APJCP.2015.16.6.2203
  5. Breast Cancer Screening Barriers from the Womans Perspective: a Meta-synthesis vol.16, pp.8, 2015, https://doi.org/10.7314/APJCP.2015.16.8.3463