Listening to voices from multiple sources: A qualitative text analysis of the emotional experiences of women living with breast cancer in China

Chaixiu Li; Cathy Ure; Wanting Zheng; Chunrao Zheng; Jianhong Liu; Chunlan Zhou; Biao Jian; Lijun Sun; Wenji Li; Lijun Xie; Yuchang Mai; Huihui Zhao; Yusheng Liu; Jie Lai; Jiaqi Fu; Yanni Wu

doi:10.3389/fpubh.2023.1114139

Listening to voices from multiple sources: A qualitative text analysis of the emotional experiences of women living with breast cancer in China

Front Public Health. 2023 Feb 3:11:1114139. doi: 10.3389/fpubh.2023.1114139. eCollection 2023.

Authors

Chaixiu Li^{1

2}, Cathy Ure³, Wanting Zheng⁴, Chunrao Zheng⁵, Jianhong Liu⁶, Chunlan Zhou¹, Biao Jian⁷, Lijun Sun⁸, Wenji Li⁹, Lijun Xie⁴, Yuchang Mai⁵, Huihui Zhao⁹, Yusheng Liu⁹, Jie Lai^{1

2}, Jiaqi Fu^{1

2}, Yanni Wu¹

Affiliations

¹ Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
² School of Nursing, Southern Medical University, Guangzhou, Guangdong, China.
³ Directorate of Allied and Public Health, School of Health and Society, University of Salford, Salford, Manchester, United Kingdom.
⁴ Vascular Thyroid Breast Surgery Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
⁵ Department of General Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China.
⁶ Office of Retirement Work, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
⁷ Software Quality Engineering Center, China Electronic Product Reliability and Environmental Testing Research Institute, Guangzhou, Guangdong, China.
⁸ Reliability and Environmental Test Engineering Center, China Electronic Product Reliability and Environmental Testing Research Institute, Guangzhou, Guangdong, China.
⁹ Department of Breast Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

Abstract

Background: Receiving a breast cancer diagnosis and treatment is both a physical and emotional journey. Previous studies using single-source data have revealed common and culture-specific emotional experiences of patients living with breast cancer. However, few studies have combined such data from multiple sources. Thus, using a variety of data sources, the current study sought to explore the emotional experiences of women in China newly diagnosed, post-operative, or undergoing chemotherapy. We posited that even though women living with breast cancer in China have multiple channels through which they can express these emotional experiences, little variance would be found in their emotional expressivity and the themes they want to express due to cultural inhibitions.

Methods: Text data from female patients newly diagnosed, post-operative, or undergoing chemotherapy were collected between June 2021 and January 2022 via a Python web crawler, semi-structured interviews, and an expressive writing intervention. Data were transcribed and subjected to thematic analysis. Reporting followed the consolidated criteria for reporting qualitative studies (COREQ) guidelines.

Results: Analyses were based on 5,675 Weibo posts and comments published by 448 posters and 1,842 commenters, transcription texts from 17 semi-structured interviews, and 150 expressive writing texts. From this total collection of 461,348 Chinese characters, three major themes emerged: (i) conflicting emotions after diagnosis; (ii) long-term suffering and treatment concerns; and (iii) benefit finding and cognitive reappraisal.

Conclusions: Despite gathering information from various sources, we found that distress from body-image disturbances, gender role loss and conflict, and changes in sexuality and fertility, were consistent among this sample of female Chinese patients with breast cancer. However, when women engaged actively in benefit finding and cognitive reappraisal with strong social support, patients were able to find ways to adapt and reported post-traumatic growth. Strong social support was an important facilitator in this growth. These study findings emphasize that healthcare professionals ought to increase cultural sensitivity, provide multiple channels to encourage patients to express their emotions, and incorporate screening for patients' emotional distress at all diagnostic and treatment phases as part of routine nursing care.

Keywords: Chinese women; breast cancer; emotional experience; psychological support; qualitative study; text analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms* / drug therapy
China
Emotions
Female
Humans

Grants and funding

This project was funded by the Guangdong Basic and Applied Basic Research Foundation (No. 2020A1515110894). The funder had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript.