Exploring the Role of Family Members in Breast Cancer Treatment Decision Making of Older African American Women

Background and Purpose: Although mortality rates from breast cancer increase for all women with age, the mortality rates are highest among older African American women.  The combination of age and ethnicity puts older African American women at high risk for poor cancer outcomes.  Inadequate treatment decision-making have been identified as one possible factor contributing to cancer disparities.  Most literature on cancer treatment decision-making has focused narrowly on the patient-physician relationship “despite the fact that most important decisions in cancer care involve at least one other accompanying family member “(Epstein & Street, 2007, p. 26).   Studies suggest that family members, particularly, husbands, daughters, and daughters-in-law play an important role in helping older African American women make decisions about breast cancer treatment.  The purpose of this study was to understand the role of family members on breast cancer treatment decision making of older African American women diagnosed with breast cancer

Methods: A qualitative phenomenological approach was utilized in this study.  In-depth interviews were conducted with 15 family members of older African American women (45 and older) who had been diagnosed with and received treatment for breast cancer. Relationships were: 3 husbands, 4 daughters, 1 daughter-in-law, 3 sisters, 2 nieces, 1 friend and 1 mother-in-law.  Participants were recruited from cancer centers in West Alabama & Birmingham.

Interviews were semi-structured, audio-taped, transcribed, and data organized with Atlasti software. Meaning units and themes were extracted from the transcripts illuminating the participants’ lived experiences.

Results: The following themes emerged from data analysis: 1) patients’ reluctance to discuss cancer with family, 2) family member concern for own health, 3) family member encouraging more aggressive treatment, 4) husbands less engaged in cancer care, 5) if you look for it, you will find it. 

Conclusions and Implications: This study focuses on a population that suffers greatly from dual racial/ethnic and age-related disparities.  This research challenges the dominant dyadic patient-physician decision-making model that ignores the role of family members in the cancer treatment decision making.  This research helps broaden the current perspective on cancer treatment decisions making to account for family involvement.  The findings of this study can have implications for family-focused interventions that would enhance the decision making process for breast cancer treatment among older African American women.