European Journal of Oncology Nursing 16 (2012) 124e130

Contents lists available at ScienceDirect

European Journal of Oncology Nursing

journal homepage: www.elsevier.com/locate/ejon

Exploration of the familys role and strengths after a young woman is diagnosed
with breast cancer: Views of women and their families
Elisabeth Coyne a, *, Judy Wollin a, Debra K. Creedy b
a
School of Nursing and Midwifery, Grifth University Logan Campus, University Drive Meadowbrook, Queensland 4131, Australia
b
Center for Mothers and Babies, University of Queensland, Australia

a b s t r a c t
Keywords: Purpose: This exploratory descriptive study examined the role and strengths of the family when sup-
Nursing porting the younger woman (<50 years) after a diagnosis of breast cancer. The perspectives of women
Young women
and family members were sought.
Family
Breast cancer
Method: Participants were recruited from oncology outpatient units in Australia. Semi-structured
Qualitative interviews interviews guided by the Family Resiliency Framework were undertaken with 14 young women with
breast cancer and 11 family members who reected on the roles of family. Transcripts were analysed
individually and in family groupings.
Results: Women with breast cancer and their family members experienced a range of emotions during
the treatment period. Roles within the family changed as members responded to their circumstances.
Analysis of interview transcripts identied the following primary themes; just being there, paradox of
help and buffer from society. A secondary theme related to support, specically the changing role of
support for family members, highlighting the strengths and experiences of family.
Conclusion: Recognition needs to be given to the complexity of changing roles experienced by young
women with breast cancer and their families. Young women with breast cancer require unique forms of
support because of the nature of their experience. Family roles were shaped through a shared sense of
commitment and open communication amongst members. Families may demonstrate a range
of strengths but are also vulnerable during this stressful period. Health professionals need to be aware
of the possible needs of families, assess their adaptation to changing circumstances, and intervene
through the provision of information, and counselling to enhance coping.
2011 Elsevier Ltd. All rights reserved.

Introduction understood (Greenstein, 2006). For younger women with breast

A diagnosis of breast cancer for women under fty years of age is
distressing and at times overwhelming for both the woman and her
family, and concerns related to child rearing and fertility are
acknowledged (Bloom et al., 2004; Huizinga et al., 2005). While
family support is acknowledged internationally, there is little
understanding of the familys role and experience during this time.
Family members are seldom included in research studies, often
because of difculties with recruitment and retention (Northouse
et al., 2006), yet family perspectives may differ from those of the
cancer sufferer (Kna et al., 2009; Walsh, 2006). Gaining an under-
standing of family functioning from several different family view-
points may allow insight into family behaviour not normally
* Corresponding author. Tel.: 61 07 33821503; fax: 61 07 33821277.
E-mail addresses: e.coyne@grifth.edu.au (E. Coyne), j.wollin@grifth.edu.au
(J. Wollin), d.creedy@uq.edu.au (D.K. Creedy).
cancer, the supporting family is important, and together they
experience change and adapt to new roles during the breast cancer
journey (Bloom et al., 2001; Coyne and Borbasi, 2009). The current
study aimed to explore the experiences and roles of family members
when supporting a younger woman with breast cancer to inform
future practice and enhance the provision of health services for the
family.
Background
Family research to date
In response to a health adversity a family will tend to function as
a group, respond to the challenge, and endeavour to adjust family
roles (Walsh, 2006). However, family members differ in their ability
to maintain stability in the face of shifting roles during an adverse
event and achieve differing levels of adjustment (Northouse et al.,

1462-3889/$ e see front matter 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ejon.2011.04.013
 E. Coyne et al. / European Journal of Oncology Nursing 16 (2012) 124e130
2001). Many families tend to maintain strong interactions and an
optimistic attitude when faced with adversity while other families
struggle (McCubbin et al., 1998). Northouse et al. (2005) in their
quantitative study of 134 dyads (patientecaregiver) identied
several concepts: role adjustment problems for family members,
illness uncertainty, and a perceived lack of support for family
members when caring for a woman with breast cancer. They also
identied the positive inuence of family support on quality of life of
both patient and family. Understanding family interactions during
health adversity provides information on how families work
together to maintain normative functioning.
Previous international research has explored family responses
to health adversity although few studies have included both the
patient and several different family members. Several studies have
used a dyad approach, recruiting the patient and one family
member, often the partner, to provide information regarding the
family response to cancer (Manne et al., 2005; Northouse et al.,
2005; Zwahlen et al., 2009). These studies highlight the benet
of family member inclusion in the research particularly to
understand the communication and interaction between the
couple. Other researchers have explored childrens responses to
parents with cancer, highlighting not only the distress felt by the
children but also their strength to adapt which reinforces the need
to include a range of family members in research (Forrest et al.,
2009; Kennedy and Lloyd-Williams, 2009; Osborn, 2007).
Womens perspectives of family support have also been investi-
gated through qualitative studies, identifying that support was
received from a wide range of family members, but the specic
nature of family roles and the strengths demonstrated in such
contexts are less well known (Bloom et al., 2004; Walsh et al.,
2005). While individual data is important, insights from a range
of family members may provide a broader perspective of family
experiences after a diagnosis of breast cancer.
Strengths of the family
Families will attempt to support each other and draw on
personal strengths to assist adjustment in response to hardship
(McCubbin et al., 1998). The Family Resiliency Framework provides
a structure for exploring family responses with a particular focus
on strengths (McCubbin et al., 1998). Strengths of the family
include commitment to the family, communication within the
family (general sharing of information, styles of communication
and humour), family roles (leadership, stability), exibility in the
face of changing circumstances, and personal appraisal of the
illness (meaning of cancer for the family) (McCubbin et al., 1998;
Walsh, 2006). Understanding these family strengths may enable
family members to understand the nature of the stressful event
and recognise changes within the family. A strength based
approach also recognises that the response and challenges may
not be all negative but rather an opportunity for personal and
family growth (Sears et al., 2003; Walsh, 2006). Although not all
families have the ability to adapt positively, several aspects of
family strengths can be explored to provide an understanding of
why some families move forward while others do not (McCubbin
et al., 1998).
Communication has been identied as a key strength when
supporting a woman with breast cancer (Lewis et al., 2008; Manne
et al., 2005). In a study with couples, Manne et al. (2005) found that
mutual open communication improved the emotional wellbeing of
both the woman and her partner. The appraisal of the stress or
illness is another strength, which inuences individuals reactions
and subsequent ability to adjust (Low et al., 2006). Coping may also
be compromised by specic contextual factors. In regards to breast
cancer, the younger woman and her family need to understand
125
treatment approaches, side effects, and disease trajectory and
communicate their concerns as they support each other.
Breast cancer in young women
Breast cancer is the second leading cancer-related cause of death
for women worldwide, with one in eight women being diagnosed
prior to the age of 85 years and twenty ve percent of these women
aged less than 50 years (AIHW, 2010; WHO, 2009). Women less than
fty years of age, are more likely to be premenopausal and in a phase
of life involving child-rearing; with different concerns related to
their condition and treatment than older women (Dunn and
Steginga, 2000). Factors associated with life cycle and social roles
of young cancer sufferers may exacerbate the breast cancer experi-
ence (Connell et al., 2006; Dunn and Steginga, 2000; Manuel et al.,
2007). The younger woman is likely to be diagnosed with a cancer
requiring aggressive multimodal treatments that have adverse
physical and psychological consequences for the woman and her
supporting family (Bloom et al., 2004; Coyne and Borbasi, 2006).
Family members report role adjustment concerns due to
increased demands for care-giving, and difculty managing the
womans side effects of treatment and cancer pain (Northouse,
2005; Yates et al., 2004). In addition, they often perceive little
support from health professionals and lack of understanding about
the health system (Northouse et al., 2005; Yates et al., 2004).
Exploration of the caregivers experience of cancer pain manage-
ment in 75 Australian caregiver dyads identied a willingness by
family members to participate in pain management care but also
a great deal of distress and difculties in this role (Yates et al.,
2004). An American study of family intervention with couples
(mean age 54 years) identied improvement of the care-giving
experience but this was not sustained over time (Northouse et al.,
2005). Working with the family to develop family strengths may
improve longer term adaptation. Changes within roles and the
associated distress for the family occurs up to 18 months after
diagnosis identifying the need for early identication and support
of family members (Bultz et al., 2000). During this time the family
aims to maintain normality but often to the detriment of family
functioning and individual family members (Northouse, 2005).
This study explored the roles and experiences of family members
when supporting the younger woman with breast cancer, and forms
part of a larger study. The main research question was What are the
strengths and resources young women and their family members
use during treatment for breast cancer?. The Resiliency Model of
Family Stress provided the theoretical framework for the study
being presented. The framework was adopted based on the
complexities of the family experience after the diagnosis of breast
cancer (McCubbin et al., 1998). This framework recognises that an
adverse event for one family member will inuence the whole
family, acknowledges the complex processes associated with family
responses, and views the family as a holistic unit. Key aspects of this
theory include: family functioning (roles), communication, coping
strategies and adjustment. The framework also recognises that the
family response is inuenced by factors such as the existence of an
extended family, culture and community. The framework allows for
exploration of how the family works together, or not, during
a stressful event (McCubbin et al., 1998). The recruitment of both
young women with breast cancer and their family members allowed
for an insight into the dynamic family environment as the whole
family adjusts to the diagnosis of breast cancer.
Method
Semi-structured interviews with young women and their
families were conducted. Participants were asked to comment on
126 E. Coyne et al. / European Journal of Oncology Nursing 16 (2012) 124e130
their experiences, role changes and perceived strengths after
a diagnosis of breast cancer.
Sample
Women with breast cancer under fty years and their family
members were recruited from ve ambulatory oncology units in
Australian: four metropolitan hospitals and a regional hospital. Invi-
tation leaets were displayed at each site and interested participants
contacted the researcher by telephone. Information about the study
was discussed, and a convenient time and place for the interview was
arranged. Inclusion criteria for the young women was a conrmed
diagnosis of breast cancer within the rst year, aged under fty years,
currently undergoing a regimen of active treatment for breast cancer,
seeing an oncologist at least every three months and being supported
by family members. Family was dened as a group of individuals
bound by strong emotional ties, a sense of belonging, and a commit-
ment to being involved in one anothers lives, calling themselves
family (Friedman et al., 2003; Wright and Bell, 2009). The women
with breast cancer could nominate up to 4 family members over the
age of 18 years to be involved in the study. Not all nominated family
members consented to be interviewed. No follow up occurred to
identify reasons for non-participation. The study received approval
from the University Human Research Ethics Committee. All interview
participants gave written informed consent.
Data collection and analysis
Semi-structured interviews, with questions based on the Resil-
iency Model of Family Stress (McCubbin et al.,1998) were completed
by each participant in their home (n 17) or conducted by telephone
if participants lived more than 200 km from the recruitment site
(n 8). This allowed for individuals living in inner regional and rural
areas (limited community resources, over 8.5 h to metropolitan
hospital) to participate. Interviews provided opportunities for open
disclosure of information. Participants were asked how the family:
(1) worked through problems, (2) worked through unexpected
problems, (3) worked together, (4) maintained open communica-
tion, (5) shared emotion, (6) solved problems and (7) who they asked
for help. Interviews were recorded and transcribed verbatim.
Transcripts were analysed using inductive qualitative tech-
niques that comprised a multi-phase thematic analysis (Braun and
Clarke, 2006; Ryan and Bernard, 2003). The rst step in the analysis
was reading and rereading of the narrative data by the rst and
second researcher. Phrases aligning with the framework were
underlined to identify themes. Recurring themes within one tran-
script and across the data set as a whole were then grouped using
a cut and sort method (Miles and Huberman, 1994). Key phrases
were then grouped into broad categories and shared collectively
with the other researcher to gain consensus. A thematic map was
constructed to see links between themes, further redening of
themes occurred as patterns within the data became visible.
Transcripts were revisited to identify missing phrases as new
themes developed. Themes discussed by family participants were
identied and checked across several family members for clarity.
Underlying assumptions and conceptualisations emerged with
successive analysis of the data and rened categories and concep-
tual domains evolved. The developing categories were explored for
links to the Family Resiliency Framework and then grouped to form
a concept map of overall research question. Final coding decisions
were based on full agreement amongst the researchers. Partici-
pants reviewed and veried their transcripts and resultant themes
to ensure rigour (Grbich, 1999; Silverman, 2003). An audit trial was
created to document the process and reasoning behind the analysis
decisions (Holloway and Wheeler, 2002).
Results
Sample characteristics
Data was obtained from 14 women with breast cancer and 11
family support persons, all white Australians. The women with
breast cancer were aged between 35 and 46 years, mean age 45
years. Support persons were aged between 18 and 65 years; three
male partners, and eight females; adult children (n 2, aged 18/20
years), sister (n 1), mothers (n 4) and an aunt (n 1). The high
percentage of supporting women reects the nature of females as
carers in society (Price et al., 2007). Participating women with
breast cancer reported undergoing a variety of treatments,
including combined surgery, chemotherapy and radiotherapy
(n 5, 36%) and a combination of surgery, chemotherapy or
radiotherapy (n 9, 64%). These are similar to breast cancer
statistics in North America (Bloom et al., 2004; Northouse et al.,
2005). No further information about the breast cancer was
collected. The phase of life demographics for the women with
breast cancer were children less than 17 years (n 6, 43%), adult
children (n 6, 43%) and no children (n 2, 14%). Participants lived
in metropolitan, inner regional or rural areas in Australia.
Themes
Analysis of data revealed family strengths, roles and experiences
from the perspective of both the woman and her family. Direct
quotations are in italics. The themes were; just being there,
paradox of help and buffer from society. A secondary theme
related to different types of support, specically the changing role
of support for family members . Different forms of support were
described by women and family members and the strengths and
experiences of members. See Table 1 for qualitative themes.
Just being there
Participating women with breast cancer and their family
members all described experiences which were grouped into a key
theme of just being there. This theme related to both a practical
presence of support but also the provision of an emotional buffer
especially during treatment. The support person provided practical
assistance to the woman during medical treatment. The strengths
and abilities of family members were used to remember details
during medical consultations, encourage questions, and negotiate
the course of treatment. Gail explained how having her daughter
attend medical consultations provided support, it gave me the
Table 1
Qualitative themes.
Family strengths Family roles
Just being there
Presence of support Help with negotiating treatment
Close emotional support Sitting with woman during treatment
Paradox of help
Being comfortable with Provision of child care, transport
accepting help
Buffer from society
Protecting the woman from Phone calls disseminating information to
additional stress family and friends
Changing role of support for
family members
Transferring roles of caring as Active provision of emotional support for
family members were family by both woman with breast cancer
supported by woman with and her family members
breast cancer
Mothers support role
Partners support role
 E. Coyne et al. / European Journal of Oncology Nursing 16 (2012) 124e130 127

condence to turn around and start questioning. Participants also the toilet and things like that but I felt really uncomfortable about
spoke of how family support often had specic roles. Mia explained people coming in .you feel you should be able to look after your
how the family chose different members to assist her during family. Robyn.
treatment, my daughter comes with me and a sister in-law, we took
Small gifts and gestures were appreciated including owers,
her because she was good at remembering stuff. Gail spoke of her
books to read, and offers to care for the children so they could rest.
daughters coming to nd out more information, My youngest
It appeared that women and their families valued additional
daughter is a nurse so she made sure she came with me, so she knew
support but not all offers for assistance were useful. The paradox
exactly what was happening . if I didnt have the girls there I would
occurs when support is needed to help the woman with cancer
have just listened and gone with the ow. Family participants told
maintain family functioning but the support provided was not
stories of how they devoted parts of their lives just to be there for
always personally acceptable. In some cases, support had negative
the woman with breast cancer. Sophie, Janes daughter, explained
psychological consequences and was an intrusion on personal
how she went with her mother to treatment sessions just to be
space.
there for her, often missing out on normal teenage activities.
I just wanted to be some moral support for her and just her Buffer from society
company because I knew sometimes shed be there for hours This theme related to the protective buffer that family provided
waiting, the doctors appointments and treatments, shed be sitting for the woman and how they themselves developed a protective
up there for a while. barrier. Karen, a single mother described how she would phone one
family member with a treatment update and ask them to phone
Support during treatments was characterised by the provision of
everyone else with news as it was too stressful for her to make
emotional support and encouragement. Support may have involved
multiple calls and impart the same news. Participants also reected
distraction, talking, doing pleasurable activities before the treat-
that some family and friends were not good sources of support. This
ment and being there during the long drive to and from hospital.
realization required protective strategies to be put in place. Robyn
Kate, Lynnes mother, spoke of the drive to the hospital, we chatted
spoke about how she ltered information to friends.
on the drive to chemo it was an unspoken rule not to mention the
cancer. Lynne also mentioned this time as reinforcing the strength You learn who can cope with what youre trying to tell them and
of support, She comes every Friday with me. so I think the bond that who you cant so, you know you develop, what to say yeah Im
its formed . its certainly shown our strengths as a family and bought ne and to other people say No Im having a bad day.
us all so much closer together. Charlie, Annas partner, described
Lynne, a single mother, commented that some friends were
how they walked before treatments to reduce the tension; .as you
unable to just be there and help her through this period of illness.
walk you burn up a lot of nervous energy. um. and I think that sort
of kept us reasonably sane. Its almost like theyll cross the road because theyre scared .
Another aspect of this support was the provision of emotional thats just their inability to deal with the word cancer because its
support at home, as family members provided close emotional a big word, its a really big word . but this has bought the family
support for the woman with cancer. Charlie spoke of his wifes closer together, we all know weve got to rely on each other.
parents, Annas very close to her mum [mother], she gets on really
Similarly, family members often ltered phone calls for the
well, they were just there and they were probably the only people we
woman to reduce possible emotional stress of talking to someone
felt really comfortable with. Other women with large families spoke
known to be less helpful. Lynne explained that her 12 year old son
of the whole family being there as well, It seemed to really come
would lter calls on the weekends after her chemotherapy to give
naturally with everyone have to be there for her . I only saw the
her time to recover unless its God I dont want to speak with them.
positive side with them all Gail. Representatives from each family
God was Lynnes mother Kate. Rachel explained how her partner
group told a story of just being there in supporting the woman with
took all the phone calls although he became exhausted from this, S
breast cancer.
took on everything, every phone call, every appointment, everything.
He just took it all on board.
The paradox of help
Family provided practical support such as child care, transport,
The changing role of support for family members
as well as shopping and meal preparation, however the trans-
A perceived strength of the family was the provision of
ference of these roles and responsibilities was not accepted by all
protection or cushioning from life outside of the breast cancer
the women as it often accentuated their vulnerability. Some
event. Women and their family members moved between the role
perceived extra help as acknowledgement of their sick role. Charlie
of supporting and being supported at different times as the
described We werent, you know inrm. I mean Anna sort of treated
family moved through the breast cancer journey. Mia talked of
herself as if she wasnt ill, it was more of a problem. The types of
times when her husband needed support Probably two days of
practical support and attitudes towards providing this support
crying, not by me, from my husband and daughter . I was just saying
varied according to family structure. Members of smaller family
Ill be right you know. Participants also talked of trying not to
units resisted some forms of practical support, whereas open
burden family members with their own distress. The women with
extended families found the provision of practical support to be one
breast cancer worried about how their partners/mothers were
less thing to worry about. Gail who was part of a big family
supported by others. Sally expressed concern about her partner
explained that everyone helped, my girls made sure everything was
during times when she struggled to cope with her condition and
spotlessly clean, meals cooked and everything else, and looked after us
admission to hospital, it was all very well for me to be leaning on him
really well . so I didnt cop any stress that way, the girls made sure.
as my support but he didnt have very much support.. Rachel
Robyn explained how the school mothers helped but it was
explained how her partner was there for her but she was uncertain
sometimes hard to accept. Help from others sometimes repre-
how he was coping, thats really hard, coping for him. I think C pretty
sented the womans inability to no longer care for her family.
much buries his head in the sand [chuckle]. Just as well he is not here to
The mums [mothers] at school rallied and did up a roster about listen to that. Samantha, Janes sister commented on her feelings of
meals . which was a huge help. . they offered to help and scrub needing help, I think it is hard for the support people because it feels
128 E. Coyne et al. / European Journal of Oncology Nursing 16 (2012) 124e130
like we have nothing . forgotten people. Samantha spoke of how
she never burdened her sister with her feelings but just kept sup-
porting Jane and Sophie (Janes daughter) through the treatment.
Mothers of women with breast cancer played a pivotal role as
support person that was both different and as important as spousal
support. The partners of women reported having a role of
protector; sheltering the woman and family from the outside
world. Mothers reported that they tried to take away the hurt and
of feeling distressed that it was their daughter and not them
suffering a life-threatening disease. Kate (Lynnes mother)
described her anguish when they sat together during chemo-
therapy. She reported saying to her daughter, I cant believe were
here having chemo and its you not me. Similarly, the women with
cancer acknowledged how their mothers often felt sorrow and
distress, yet tried to make sure they were always there for their
daughters. Rachel explained how her parents provided support so
Ive got my Mum and Dad here, still alive and theyve been excellent
offering more intimate things I suppose like nances if we needed it,
and Mums there you know whenever.
Partners reported different levels of psychological distress.
Some male partners reported hiding their true feelings from the
woman with cancer in an attempt to shield them from their
distress, and yet the women perceived the distress. Gail
commented
I know my husband hid a lot from me because he didnt want me to
see how distressed he was. It is only now, later that hes come clean
and admitted it just absolutely terried him . I think he could
have probably done with a bit of counselling. Gail.
Conversely, Charlie (husband of Anna in a family with a two year
old child) commented that they shared and talked openly the
whole time. yeah youve got to cry . one day I actually threw up.
um. because I felt so bloody awful about it all. The partners role
was about supporting and accepting decisions. Charlie explains, I
tried to be sort of not judgmental in the way she wanted to go, the way
she wanted to manage. Mias husband also openly showed his
emotions but with acceptance was able to develop a new role of
protector. Mia commented He spent the whole weekend crying and
that really shocked me, but once he did that, he then moved on and he
was strong, he was my protector. It was this positive strength which
helped some women stay positive and work out plans together as
a family as a survival mechanism.
Discussion
The current study provided unique insights on the younger
womans perspective of her family during her breast cancer journey
and the family members experience. This expands on previous
research, which has predominantly explored the experiences of
women, or older women with breast cancer, or a dyad approach to
family support. The analysis of data identied the different roles
and responses of the family during their adjustment to breast
cancer and those of the woman with breast cancer. Key ndings
related to the strength of family in providing emotional and prac-
tical support, negotiating the helping role, and understanding
when they themselves needed help.
The Family Resiliency Framework informed an understanding of
the strength of family support, revealing the quiet supporting role
of family; a role of being there providing emotional support.
Family participants spoke of forming bonds, staying positive
through the journey, and about the dynamic nature of their being
there role. Previous research exploring the husbands perspective
of supporting their wife with ovarian cancer described a similar
theme, changes in the marital relationship both positive and
negative as they supported the woman with ovarian cancer (Ponto
and Barton, 2008). Fergus and Gray (2009) explored relationship
vulnerabilities of couples during breast cancer noting different
levels of support and adjustment comparable to the current
research. Although the women in this research often wanted close
support, they were mindful of the emotional needs of family, and at
other times they needed space to nd themselves in their personal
journey. Both the women and their family members often guarded
their distress, and did not share this openly or only asked for
support when they were unable to achieve their emotional balance.
This nding is consistent with that of Manne et al. (2005) who
discussed similar changes in communication between couples
when coping with breast cancer.
The support role of family members through just being there
was varied and characterised by companionship, distracting the
woman from thinking about the breast cancer, and participating in
medical consultations. These roles were performed by different
family members depending on the individual needs of the woman.
The ability of the family to be exible and manage changing roles in
response to stressful circumstances can reduce the overall level of
anxiety of members and maintain family functioning (Board and
Ryan-Wenger, 2000; Mellon and Northouse, 2001).
The theme of the paradox of help related to being able to accept
support for practical concerns such as child-minding, transport and
home help. Participants talked about this practical support role as
one which reduced the stress for the woman with breast cancer and
conrms previous research ndings on family resilience (Walsh
et al., 2005). Effective practical support was predicated on good
communication to enable open discussion about the personal
distress experienced by the women, negotiating changing roles and
responsibilities, and accepting the need for additional help. The
paradox of help was linked to family dynamics and inuenced
which resources and coping strategies the family group used.
Northouse (2005) noted that communication styles inuence the
ability of family to work together and seek outside assistance.
Although at times accepting help was seen by the woman in the
current study as an inability to maintain her own role within the
family, there was variability amongst participants. Perceptions of
practical support reected the womans personal appraisal of her
illness as either a positive challenge where extra help was needed
or as a negative inuence on her self-concept as carer/homemaker
in her family. Consistent with the Family Resiliency Framework, the
appraisal of the situation greatly inuenced the family dynamics
and adjustment (McCubbin et al., 1998).
The ndings from the current study identied that family
formed a buffer from society for the woman with breast cancer.
Related to the appraisal of the breast cancer and individual coping
strategies, participants acknowledged that some people outside the
family were unable to cope with the implications of the cancer
diagnosis. The women with breast cancer avoided contact with
these people in an attempt to reduce their own distress and
maintain a positive self-belief. This is consistent with ndings from
previous research that explored positive reappraisal after breast
cancer diagnosis, identifying the strength in being able to nd
meaning in adversity (Low et al., 2006; Sears et al., 2003). Partici-
pants acknowledged that some individuals were unable to cope
with the implications of the cancer diagnosis and they avoided
contact with these people in an attempt to reduce their own
distress. However lack of acceptance and withdrawal of others may
consequently increase the distress for the woman with breast
cancer (Northouse, 2005). The ability to normalise the stress of
a situation was similar to ndings of previous studies (Walsh,
2006), where it was noted that an individuals past experience
altered their ability to cope with the current crisis. Being able to
accept feelings of distress becomes a journey of personal growth
when faced with a crisis. It is important for health professionals to
 E. Coyne et al. / European Journal of Oncology Nursing 16 (2012) 124e130
acknowledge such distress and support family members to provide
effective support and move forward in face of this adversity.
An interesting nding from this analysis was the oscillation
between being supported and supporting, and the particular
challenges this brought for the family. This was evident in inter-
views with several members of the same family. If the family
experienced difculty openly communicating their needs and role
changes were not achieved, feelings of disappointment and
emotional distress occurred. Previous research has reported links to
social support networks and better mental and physical wellbeing
(Bloom et al., 2001) highlighting that support is a critical factor in
recovery for both the woman and her family.
The different roles of the mother and partner of the woman with
cancer highlighted the intricate nature of human responses to
stress. The mothers in the current research discussed wanting to
take the pain away from their daughters and how they felt anguish
for their daughter. Previous research has not explored the mothers
role in caring for an adult with cancer and further exploration
would be needed to expand on these ndings. In research on
paediatric cancer, Svavarsdottir (2005) found that the emotional
burden of caring for a sick child inuenced the whole family,
however mothers reported higher emotional and physical burden
than fathers. As people live longer it is more likely that parents will
at some time provide care for their adult child experiencing an
illness. The experience of mothers supporting their adult children
needs to be acknowledged by health professionals and opportuni-
ties provided for these mothers to grieve and resolve guilt, and gain
acceptance of the current circumstances.
Partners in the current research described themselves as
shielding, and being emotionally strong for their spouse during
the breast cancer journey in a protective role. The partners role has
been explored in research by Walsh et al. (2005) who reported that
the women described an improvement in emotional closeness if
open communication was able to be maintained. The partners in
this research reported high levels of emotional distress and a lack of
personal support from others. Similarly, Fergus and Gray (2009)
also identied high levels of distress by partners when facing the
challenges of supporting their spouse after a diagnosis of breast
cancer.
The current research explored the family after a diagnosis of
breast cancer and, consistent with the Family Resiliency Framework
ndings, revealed that and individual appraisal strengths inu-
enced overall family functioning. Expanding on previous research,
the current ndings identied strengths of the supporting family
were the familys ability to maintain open communication and be
exible about family roles. The family provided both emotional and
practical support, and these roles were underpinned by a strong
sense of commitment.
Limitations of the study
This study has methodological strengths due to the inclusion of
a range of family members as participants but there are also several
limitations. The nature of the study required consent not only from
the woman but also family members, and it could be that families
struggling with their support role did not volunteer to participate.
Results and conclusions of the current study cannot be generalised
to the broader population of families supporting a person with
cancer as it was not possible to obtain a representative sample of
participants. However, twenty-ve interviews were conducted
with a broad range of participants which provides some condence
in the ndings. Steps were also taken to maintain rigour in the
research processes and ensure that the identied themes were
reective of the views of participants.
129
Conclusion
Few studies exploring the experience of cancer have included
family members as participants. Findings of the current study
provide unique insights of family members roles, strengths and
experiences during the breast cancer journey for the younger
woman. The ndings also provide an understanding of the wom-
ans perspective of her family from a strengths perspective. Various
roles were revealed, and the need for good communication
amongst family members, exibility, and commitment were high-
lighted. Although family assisted the woman through their pres-
ence and practical support, there was a paradox whereby not all
support was helpful and this was inuenced by the womens
personal appraisal of her adjustment. The roles adopted by family
assisted the woman to adjust to the diagnosis of cancer, but also
facilitated reciprocal support by the woman to her family.
Conict of interest statement
None declared.
References
AIHW, 2010. Australian Institute of Health and Welfare Retrieved 15.02.10, from
http://www.aihw.gov.au/.
Bloom, J.R., Stewart, S.L., Chang, S., Banks, P.J., 2004. Then and now: quality of life of
young breast cancer survivors. Psycho-Oncology 13 (3), 147e160.
Bloom, J.R., Stewart, S.L., Johnston, M., Banks, P., Fobair, P., 2001. Sources of support
and the physical and mental well-being of young women with breast cancer.
Social Science & Medicine 53 (11), 1513e1524.
Board, R., Ryan-Wenger, N., 2000. State of the science on parental stress and family
functioning in pediatric intensive care units. American Journal of Critical Care 9
(2), 106e119.
Braun, V., Clarke, V., 2006. Using thematic analysis in psychology. Qualitative
Research in Psychology 3, 77e101.
Bultz, B.D., Speca, M., Brasher, P.M., Geggie, P.H.S., Page, S.A., 2000. A randomized
controlled trial of a brief psychoeducational support group for partners of early
stage breast cancer patients. Psycho-Oncology 9 (4), 303e313.
Connell, S., Patterson, C., Newman, B., 2006. Issues and concerns of young Austra-
lian women with breast cancer. Supportive Care in Cancer 14 (5), 419e426.
Coyne, E., Borbasi, S., 2006. Hold it all together: breast cancer and its impact on life
for younger women. Contemporary Nurse 23 (2), 156.
Coyne, E., Borbasi, S., 2009. Living the experience of breast cancer treatment: the
younger womens perspective. Australian Journal of Advanced Nursing 26 (4),
6e13.
Dunn, J., Steginga, S.K., 2000. Young womens experience of breast cancer: dening
young and identifying concerns. Psycho-Oncology 9 (2), 137e146.
Fergus, K.D., Gray, R.E., 2009. Relationship vulnerabilities during breast cancer:
patient and partner perspectives. Psycho-Oncology 18 (12), 1311e1322.
Forrest, G., Plumb, C., Ziebland, S., Stein, A., 2009. Breast cancer in young families:
a qualitative interview study of father and their role and communication with
their children following the diagnosis of maternal breast cancer. Psycho-
Oncology 18 (1), 96e103.
Friedman, M.M., Bowden, V.R., Jones, E.G., 2003. Family Nursing Research, Theory,
and Practice, fth ed. Printice Hall, New Jersey.
Grbich, C., 1999. Qualitative Research in Health an Introduction. Allen & Unwin, St.
Leonards.
Greenstein, T.N., 2006. Methods of Family Research, second ed. Sage Publications,
London.
Holloway, I., Wheeler, S., 2002. Qualitative Research in Nursing, second ed. Black-
well Science, Oxford.
Huizinga, G.A., Visser, A., Van der graaf, W.T., Hoekstra, H.J., Hoekstra-weebers, J.E.,
2005. The quality of communication between parents and adolescent children
in the case of parental cancer. Annals of Oncology 16, 1956e1961.
Kennedy, V.L., Lloyd-Williams, M., 2009. How children cope when a parent has
advanced cancer. Psycho-Oncology 18 (8), 886e892.
Kna, G.J., Dixon, J.K., OMalley, J.P., Grey, M., Deatrick, J.A., Gallo, A.M., Kna, K.,
2009. Analysis of cross-sectional univariate measurements for family dyads
using linear mixed modeling. Journal of Family Nursing 15 (2), 130e151.
Lewis, F.M., Cochrane, B.B., Fletcher, K.A., Zahlis, E.H., Shands, M., Gralow, J.R.,
Wu, S.M., Schmitz, K., 2008. Helping her heal: a pilot study of an educational
counseling intervention for spouses of women with breast cancer. Psycho-
Oncology 17 (2), 131e137.
Low, C.A., Stanton, A.L., Danoff-Burg, S., 2006. Expressive disclosure and benet
nding among breast cancer patients: mechanisms for positive health effects.
Health Psychology 25 (2), 181e189.
Manne, S.L., Ostroff, J.S., Norton, T.R., Goldstein, L., Grana, G., 2005. Cancer-related
relationship communication in couples coping with early stage breast cancer.
Psycho-Oncology 15 (3), 234e247.
130 E. Coyne et al. / European Journal of Oncology Nursing 16 (2012) 124e130
Manuel, J.C., Burwell, S.R., Crawford, S.L., Lawrence, R.H., Farmer, D.F., Hege, A.,
Phillips, K., Avis, N.E., 2007. Younger womens perceptions of coping with breast
cancer. Cancer Nursing 30 (2), 85e94.
McCubbin, H.I., Thompson, E.A., Thompson, A.I., Fromer, J.E., 1998. Stress, Coping,
and Health in Families. SAGE Publications, California.
Mellon, S., Northouse, L., 2001. Family survivorship and quality of life following
a cancer diagnosis. Research in Nursing & Health 24 (6), 446e459.
Miles, M.B., Huberman, A.M., 1994. Qualitative Data Analysis: An Expanded
Sourcebook, second ed. SAGE, Thousand Oaks CA.
Northouse, L., 2005. Helping families of patients with cancer. Oncology Nursing
Forum 32 (4), 743e750.
Northouse, L., Kershaw, T., Mood, D., Schafenacker, A., 2005. Effects of a family
intervention on the quality of life of women with recurrent breast cancer and
their family caregivers. Psycho-Oncology 14 (6), 478e491.
Northouse, L., Rosset, T., Phillips, L., Mood, D., Schafenacker, A., Kershaw, T., 2006.
Research with families facing cancer: the challenges of accrual and retention.
Research in Nursing & Health 29 (3), 199e211.
Northouse, L., Templin, T., Mood, D., 2001. Couples adjustment to breast disease during
the rst year following diagnosis. Journal of Behavioral Medicine 24 (2), 115e136.
Osborn, T., 2007. The psychosocial impact of parental cancer on children and
adolescents: a systematic review. Psycho-Oncology 6 (2), 101e126.
Ponto, J.A., Barton, D., 2008. Husbands perspective of living with wives ovarian
cancer. Psycho-Oncology 17 (12), 1225e1231.
Price, S., Noseworthy, J., Thornton, J., 2007. Womens experience with social pres-
ence during childbirth. MCN The American Journal of Maternal Child Nursing
32 (3), 184e191.
Ryan, G.W., Bernard, H.R., 2003. Techniques to identify themes. Field Methods 15
(1), 85e109.
Sears, S.R., Stanton, A.L., Danoff-Burg, S., 2003. The Yellow Brick Road and the
Emerald City: benet nding, positive reappraisal coping, and posttraumatic
growth in women with early-stage breast cancer. Health Psychology 22 (5),
487e497.
Silverman, D. (Ed.), 2003. Qualitative Research Theory, Method and Practice. SAGE
Publications Ltd, London.
Svavarsdottir, E.K., 2005. Caring for a child with cancer: a longitudinal perspective.
Journal of Advanced Nursing 50 (2), 153e161.
Walsh, F., 2006. Strengthening Family Resilience, second ed. The Guilford Press,
New York.
Walsh, S.R., Manuel, J.C., Avis, N.E., 2005. The impact of breast cancer on younger
womens relationship with their partner and children. Families, Systems, &
Health 23 (1), 80e93.
WHO, 2009. World Health Organisation Retrieved 21.04.09, from http://www.who.
int/en/.
Wright, L.M., Bell, J.M., 2009. Beliefs and Illness A Model for Healing. 4th Floor Press
INC, Canada.
Yates, P., Aranda, S., Edward, H., Nash, R., Skerman, H., McCarthy, A., 2004. Family
caregivers experiences and involvement with cancer pain management. Jour-
nal of Palliative Care 20 (4), 287e297.
Zwahlen, D., Hagenbuch, N., Carley, M.I., Jenewein, J., Buchi, S., 2009. Post-
traumatic growth in cancer patients and partners-effects of role, gender and
the dyad on couples posttraumatic growth experience. Psycho-Oncology 19
(1), 12e20.