"I Just Really Wanted to be There for Her": Results from Dyadic Interviews with Black Breast Cancer Survivors and Their Caregivers

Background and Purpose: Black breast cancer patients often receive support from informal caregivers such as daughters, sisters, friends, and mothers. We conducted dyadic interviews with Black patients and their female caregivers to understand how they responded to cancer as a pair.

Methods: Ten patient-caregiver dyads (N = 20 participants) recruited from a larger study took part in semi-structured Zoom interviews, first together and then in separate breakout rooms. Our interdisciplinary team conducted a directed thematic analysis using Dedoose software. Two team members coded transcripts independently and then reached consensus on codes. Themes were developed through memos, discussions, and comments on written drafts. These analyses are based on the joint component of the interview and include findings about dyadic interactions and contexts. Descriptive data (demographics and depressive symptoms, measured by the Center for Epidemiologic Studies Depression scale [CES-D]) come from the baseline survey of the larger study.

Results: Dyads were daughters caring for mothers (7); pairs of friends (2), and a mother caring for her daughter (1). All patients and caregivers identified as non-Hispanic Black. Average age was 55.5 (SD = 12.8) for patients and 43.9 (SD = 14.2) for caregivers. Fifty percent of patients and 40% of caregivers reported incomes of under $40,000; 70% of patients and 70% of caregivers reported attending at least some college. Mean CES-D score was 18.9 (SD = 8.4) for patients and 12.5 (SD = 9.7) for caregivers.

Three main themes were identified. The first was the complexity of family comorbidity (i.e., dealing with family health issues beyond the patient’s cancer diagnosis). For example, a patient said, "During the time that I was told that I had cancer, I have a brother, and he was also going through cancer. ...and then... I always, you know, fight depression... Then I thought about my sister that I lost to cancer." The second theme was overlap between practical and emotional support (the two most common codes). One caregiver said, "I just really wanted to be here for whatever she needed. ...[A] lot of times I would make food for her, and either she could, or she couldn’t eat anything depending on... the situation. Any time she needed just to get away, or, you know, just somewhere to vent.... I just really wanted to be there for her through her difficult time." The third theme was the importance of faith for staying strong. One caregiver said, "I’m a Christian, so... I lean on the Lord a lot. And... He gave me the strength to make it through. ... I didn’t feel like I was doing too much. I didn’t feel like I was overburdened. Even though... I got a lot going on in my own life, it was apparently my season to do that for her."

Conclusions and Implications: Patients and caregivers described a complex family and social context that offered both challenges and support. Our findings suggest that clinicians should assess the non-cancer challenges cancer patients and caregivers face in order to support both members of a dyad.