Helping Diagnosed Mothers and Their Adolescent-Young Adult Daughters Navigate Challenging Breast Cancer Conversations

Abstract

Background: Mothers diagnosed with breast cancer describe daughters as a critical source of support. Talking about breast cancer is especially distressing and challenging for mothers and their adolescent-young adult (AYA) daughters. Objective: The over-arching study aim was to generate findings to integrate into an intervention to enhance diagnosed mothers’ and AYA daughters’ communication skills by identifying approaches they find helpful when talking about cancer. Methods: We recruited 27 women (12 dyads). Diagnosed mothers and their AYA daughters (aged 18–29) participated in individual, in-depth, semi-structured interviews. Transcripts were thematically analyzed. Mothers’/daughters’ perspectives were compared/triangulated. Results: Both mothers and daughters identified 3 approaches that helped them navigate cancer communication: (mothers) initiate conversations, keep communication positive, and limit cancer conversations. Only mothers reported it was helpful to downplay the seriousness of cancer. Only daughters identified it was important for them to reframe their perspective of mothers’ disclosures. Conclusions: Findings provide clinicians like nurses and families with a “psychosocial map” of communication approaches and associated strategies mothers and AYA daughters can use to talk about breast cancer in ways that promote daughters’ comfort and/or alleviate distress. Implications for Practice: Findings capture communication skills to focus on when tailoring developmentally focused interventions targeting diagnosed mothers and AYA daughters. Nurses can translate findings into practice to help patients talk to AYA daughters about cancer, thereby promoting a family-centered cancer care approach. What Is Foundational: AYA daughters are especially distressed talking about cancer with their diagnosed mothers. They can both use communication strategies to enhance their communal coping.

Young Adult Caregiving Daughters and Diagnosed Mothers Navigating Breast Cancer Together: Open and Avoidant Communication and Psychosocial Outcomes

“…For example, both mothers and YACDs emphasized the need for open, honest communication, and mothers felt supported when YACDs were willing to talk. They also stressed the importance of staying positive, an approach preferred by non-caregiving AYA daughters and diagnosed mothers [55]. Both mothers and YACDs in our study also identified a new strategy-third-party involvement-which focused on receiving guidance from other sources on how to talk to each other.…”

“…While cancer talk and care conversations are challenging, learning to navigate such discussions is necessary to not only promote better health outcomes but also foster YACDs' ability to provide care (and for their mothers to receive it). Research has demonstrated not only the importance of facilitating openness in cancer caregiving and coping, but also providing targeted guidance in line with developmental differences such as maturity level and sociohistorical differences in women's preferences for disclosing health information [55]. The findings herein provide further direction for a communication skills intervention to help YACDs and their mothers talk about care-related issues in a manner that is health-promoting.…”

“…They not only describe challenging relational dynamics, but they also engage in maladaptive communication patterns [2,5,10,12,17,[45][46][47][48][49][50]. Unlike older mother-adult daughter age groups, AYA daughters consistently engage in avoidant behavior, withdrawing from or avoiding cancer-related communication with their mothers, which contributes to both AYAs' and their mother's distress [4,5,43,[51][52][53][54][55]. While limited, research has shown that AYAs and their mothers struggle with talking about daughters' future breast cancer risk, negative affect like feelings of sadness, and mothers' clinical experiences particularly physical changes after a mastectomy [51].…”

“…A recent study identified several strategies both AYAs and their diagnosed mothers perceive as helpful when having breast cancer-related discussions, including having mothers initiate the conversation, keeping the focus positive, and limiting the conversations [55]. However, no studies have examined AYAs who self-identify as caregivers of their diagnosed mothers (i.e., YACDs) although they are increasingly serving as mothers' caregivers and are at a higher risk of burden and distress [21][22][23][24][25]41,[46][47][48]63].…”

Breast cancer treatment and recovery: pets’ roles as emotional buffers and stressors

“…Many people diagnosed with breast cancer struggle with depression and anxiety [ 134 , 135 , 137 ], and having dependents can exacerbate these negative effects [ 14 , 65 ]. Unfortunately, despite the need for family-centered psychological support, it remains rare and underutilized [ 135 , 145 – 147 ].…”