Abstract

Previous inquiry indicates that social support is benign to cancer patients in adjusting to the stress of the affliction. Drawing on a qualitative content analysis of 36 semi-structured interviews, this article explores sources and types of social support in Arab-Palestinian women with chest cancer. Results show that members of the immediate family unit, husbands in item, are reported to be the most supportive social sources. Given the limitations that characterize admission to cancer intendance in the occupied Palestinian territory (OPT) and the collectivistic values of the guild, women with breast cancer seem to rely mainly on their husbands to handle emotional, functional and advisory needs. Emotional back up includes the provision of intendance, trust, reassurance, and companionship. Functional support includes the practical assistance that the cancer patients receive in terms of financial support, attendance during treatment or assistance with domestic chores and childcare. Accessing appropriate informational support can exist quite challenging in the OPT since available information is not e'er reliable. The family plays a key role in mediating communication with doctors. Contact with breast cancer patients and survivors is also a source of supporting information, with however a possible negative impact in terms of emotional coping. In this context, the immediate family becomes a fundamental resources for coping and a relational infinite that mediates connections with others, including doctors, acting as a "proxy" between the patient and the social environment. Findings are discussed in light of the historical and sociocultural context of the OPT.

Citation: Almuhtaseb MIA, Alby F, Zucchermaglio C, Fatigante M (2021) Social support for breast cancer patients in the occupied Palestinian territory. PLoS ONE sixteen(six): e0252608. https://doi.org/10.1371/periodical.pone.0252608

Editor: Weeam Hammoudeh, Birzeit University Institute of Community and Public Health, STATE OF PALESTINE

Received: November 24, 2020; Accepted: May 18, 2021; Published: June 18, 2021

Copyright: © 2021 Almuhtaseb et al. This is an open up access article distributed under the terms of the Artistic Commons Attribution License, which permits unrestricted utilise, distribution, and reproduction in any medium, provided the original author and source are credited.

Information Availability: The consummate data corpus that supports the findings of this study is not publicly available due to privacy reasons, since information technology contains information that could compromise enquiry participant privacy. Nonetheless, all relevant data required to replicate the written report'due south findings are inside the newspaper.

Funding: This piece of work was supported past the Sapienza University's inquiry grant 2018 n. RP118164126B8AD1, P.I.: Francesca Alby.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Previous research indicates that social support is benign to cancer patients in adjusting to the stress of the affliction [1]. Social relations have in fact proved to be important resources for patients to mobilize in coping with cancer [ii]. Typically, such resource have a positive impact non only on the patient'due south psychological response to cancer, merely as well on her physiological reaction to the disease [3, 4].

There is a general agreement among researchers that affliction normally restricts the patient from participating in social activities; this in turn ways that a cancer patient's opportunities of interacting with others, and hence of accessing social back up, may subtract. Alternatively, patients themselves may decide to withdraw from their social relations network. In either example, this is related to the patient's experience of cancer which depends on such variables as the patient'due south demographic characteristics (such as age, gender, socioeconomic condition), and medical condition (such equally the site of malignancy, phase of illness, and type of treatment) [five].

In this regard, Kleinke [6] maintains that a person who has strong social support, viewed in terms of the number and strength of his relationships, is more probable to be optimistic and less likely to be depressed than those with fewer or weaker social relationships. In addition, social support increases the patients' feeling of reassurance and provides them with strength [7, eight].

Several studies focusing on social support for breast cancer patients have been conducted in high-income countries. For instance, a Norwegian study conducted in 2011 utilizing interviews with 21 breast cancer patients (41–73 years) who had already received diagnosis and were waiting for surgery, indicated that the menses between diagnosis and surgery was characterized by a lot of fatigue and psychological stress. The results besides revealed that the degree of back up these patients were provided with, likewise equally the information and consultation they received from people who were close to them or from professionals and health care providers, reassured them. In addition, the participants reported that when they received the diagnosis results, they were accompanied by a close person [9]. On the other mitt, Kroenke et al.'s written report [2], which aimed to examine the affect of social relations on the lifestyle of three,139 breast cancer patients in the The states, revealed that patients who were socially isolated had a depression quality lifestyle and a deteriorating concrete health, and social and emotional life. The results likewise indicated that large social networks and a coherent social back up are associated with college standards of living after the phase of diagnosis with breast cancer.

Al-Azri et al. [10] documented that in lower-income countries women with breast cancer are at an increased risk of physical and psychological morbidities later diagnosis, such as distress, anxiety, depression and concerns relating to children and family unit brunt, torso epitome and sexual and marital relations [11, 12]. All the same, social barriers and the false behavior virtually cancer and its clan with death for many lodge members bear upon a patient's daily life fifty-fifty by avoiding mentioning its name or talking about topics related to the disease [12–21]. In addition, several studies take showed that in the Arab and Palestinian order, a powerful social stigma is nevertheless attached to cancer [13, 22, 23]. For this reason, breast cancer patients try to hibernate the diagnosis and treatment from their neighbors, friends and colleagues in the workplace. To exercise so, they generally refrain from attention social gatherings and participating in celebrations [24–26]. Consequently, these patients are nearly likely reluctant to share their experience with others, or might be denied access to social support and may and so become socially isolated for fear of disapproval or rejection [ii, 27]. The obverse is too true; that is, increasing the size of a person's social network influences the corporeality of social back up received [28].

One of the principles in wellness psychology is the hypothesis that social back up provided by trustworthy people has a significant importance in confronting the challenges relating to a disease (e.g. sharing bad news) [29]. This blazon of back up tin reduce the negative impacts on wellness [thirty]. In this respect, Kayser, Cheung, Rao, Chan, Chan, and Lo [31] analyzed breast cancer dyadic coping strategies amongst a sample of couples from Asia (Hong Kong-China, Bharat) and the U.s.. The analysis of the narratives of 28 couples revealed that in that location are iv social and cultural factors which influence the process of coping with breast cancer: (1) family boundaries, (ii) gender roles, (three) personal control, and (4) interdependence. Some couples in the study stated that they were able to overcome the prevailing cultural standards and consequently were able to attain balance in their life and were capable of adapting positively with the affliction. The study farther indicated that there are clear differences between couples from Asian cultures and American couples in terms of involving the extended families of the couple in each stage of the disease, including the discovery of the disease and treatment decisions (i.e. family members presented different suggestions). In the interviews, Chinese couples, for example, indicated that the degree of the disease impacted non only the couple just also the entire family unit. Similarly, Kayser, Watson, and Andrade [32], examined how couples describe their coping strategies with breast cancer and found that social relationships tin can advance or hinder the coping process when the married woman has breast cancer. This tin be attributed to what we call "the relationship awareness", which involves thinking about one's relationship in the context of the disease. In addition, the study indicated that the married man tends to concentrate more on problem-focused and task-oriented strategies, such as collecting data about the disease, peculiarly regarding treatment, while the patient (i.e. the wife) is more likely to be emotionally-focused and concerned virtually expressing her feelings and communicating her stress to her partner. A like written report [33] found that couples react as an emotional system rather than every bit individuals; the study also stressed the need to understand the factors that influence distress.

Based on the results of these studies, the critical role of social back up in profitable individuals, especially breast cancer patients, should exist emphasized. Social support provides cancer patients with intendance and attention, and helps them to overcome their fearfulness and anxiety from the illness too as to mitigate the difficulties they face during the various stages of the disease.

Research has shown that the family plays an indispensable function in providing social support. In the literature, all the same, the word "family" is used in different ways: sometimes it refers to the extended family; at other times, it is used in reference to the couple (i.e. husband and married woman). The variable use of the word family is related to different social and cultural practices in the dissimilar countries [34–36]. Furthermore, the importance of the blazon of relationship varies by age such that being married is more than important to younger individuals; whereas having a larger network of relatives and friends is more important as one grows older [27].

This article explores sources and types of perceived social back up in Arab-Palestinian women with breast cancer. To date very few studies have focused on this detail population, where women are coping with cancer while living under occupation in difficult conditions.

Although the incidence charge per unit of chest cancer is lower than that in Western countries or in Israel, in the Occupied Palestinian Territory, breast cancer is the 2d most common cause of death amidst women [24–26]. It is therefore particularly important to better sympathise women's coping resource through culturally sensitive studies that take into account the specificities of the context of the Occupied Palestinian Territory.

Nosotros aim to explore who they perceive to be helpful in facing their illness and in what ways. Specifically, we aim to respond the following questions: Who helps and supports these women during their illness? What are the types of social support that they receive?

Materials and methods

Methods

The study was conducted in two medical centers: 1) the Oncology Section at Beit Jala Government Hospital in Bethlehem Governorate, equally it is a significant government infirmary in the occupied Palestinian territory (OPT) which provides a large part of diagnostic and therapeutic services for oncology patients, and 2) Dunya Women's Cancer Eye in Ramallah Governorate since it is the but not-profit center that provides early diagnostic services for breast cancer and gynaecological services in the occupied Palestinian territory.

The written report was ethically approved past the Palestinian Ministry of Health. Contact with participants was mediated past the two medical centers. All participants were approached at the centers, informed of the aims of the study and requested to sign a consent form. Participants were as well fully bodacious of the anonymity and confidentiality of all the information collected for the purpose of the study. The information collection started on 18 January 2015 and ended on fifteen April 2015 due to the increased tension in the area and the consequent restrictions to mobility enforced by the Israeli occupation.

The participants recruited for the study were 36 women selected according to the post-obit inclusion criteria: 1) living in the occupied Palestinian territory; 2) been diagnosed with breast cancer between one month-three years prior to the interview; iii) having no previous history of other forms of cancer, since we were interested in how women cope with a "kickoff time" cancer diagnosis and treatment; 4) providing verbal consent and signing an informed consent form.

In the current report, semi-structured interviews were conducted as a mode to obtain "thick descriptions" of the women'south experiences and perspectives [37, 38]. Narrative interviews with patients were selected equally the main data gathering tool as "Telling stories virtually affliction is [a means] to requite a voice to the body" [39, p. 18].

The interview guide had three sections. The first section explored how the illness was discovered, the second section focused on the communication with doctors and the treatment decision-making process and the third section explored the coping resources used by the study participants, specifically the resource of support in facing cancer.

This article focuses on the answers given to questions within the third section (What was near helpful in coping with the disease? Who supported you in this experience? How did the others—family, relatives, friends—react to your illness?).

The interview besides covered socio-demographic characteristics (age, place of residence, didactics, marital status, employment status, how many children, religion) and medical information (date of diagnosis, stage, type of treatment).

The interviews were conducted in a private room (in the hospital or at the center) past one of the authors (K.A.I.), who was an Arab-Palestinian woman, which facilitated advice with the interviewees and their involvement in the inquiry (there was no refusal to participate). She presented herself as a researcher and a doctoral student in social psychology. The participants were informed nearly the aims of the study and signed a consent form. All interviews were conducted in the Palestinian dialect of Arabic. They were audio recorded, transcribed in Standard arabic and later translated into English.

The analytical procedures used on the data corpus included: 1) a verbatim transcription of all the interviews and 2) a qualitative content analysis of the interview transcripts. We used an inductive process for the construction of coding categories [40–42]. In a first phase, 2 researchers read the transcripts of the interviews identifying the categories of content to be used for coding. In a second phase, these categories were compared and subsequently used to carry out the coding of the transcripts. The analyzes were carried out independently by the ii researchers. Doubtful cases were discussed with a third researcher until an understanding was reached. The "saturation" level of the data was a matter of give-and-take and the data nerveless were considered sufficient for a qualitative exploratory assay of sources and types of social support. In the article the extracts selected: 1) were representative of the identified categories; 2) showed the diversity of means in which social back up is realized within the identified categories.

Results

Participants' characteristics

The study participants included 36 Arab-Palestinian women diagnosed with breast cancer. Eight of the participants had a history of cancer in the family. The participants were residents of the OPT, and half of them were village residents. The participants' age ranged between 22–67 years. The educational level of participants ranged from full illiteracy to academy level education. The majority of the participants were married (N = 31); of the other participants, one was abased by her husband subsequently she was diagnosed with cancer, one was widowed, ane was divorced and three were single. Near of the interviewees were housewives (Northward = 24). The number of children for thirty participants ranged from 1 to 9 children, while only six participants had no children. Almost half the participants (N = 17) said that they did non know at which stage of the disease they were when they were diagnosed with cancer; v reported that they were diagnosed at stage I, nine participants in stage Ii, three in stage 3, and three at stage Four. Regarding treatment, fourteen participants reported that they had completed treatment (i.e. chemotherapy), though they all the same had to undergo follow upwardly tests and diagnostic images regularly according to post treatment follow up guidelines.

Sources of social support for Arab-Palestinian breast cancer patients

Social relations were described by the interviewees every bit the main source of support in facing the illness, together with organized religion and organized religion [see also 43]. To be more specific, slightly less than half of the study participants (Northward = 17) asserted that their husbands were most supportive of them during their experience with the illness. Eleven participants said that their family unit, in the wide sense, stood abreast them at all the stages of the illness. However, 7 participants indicated that some of their family members were completely unaware of their illness. These participants were all women with children who wanted to continue their condition from their children in order to avoid causing them whatsoever pain or distress or anxiety about their disease, or to brand sure that their schoolhouse-age children remain focused on their study. Based on these results, information technology seems that certain members of the close family (hubby, mother, siblings) may exist selected to be involved in the care and support of a chest cancer patient, while other family members may not exist involved or even informed almost the disease (children, quondam parents) with the intent of protecting them from feelings of anxiety or distress. It is worth mentioning that several study participants reported receiving little or no social support from healthcare providers, social workers or friends.

Drawing both on the qualitative content analysis and on a review of the previous literature [vii, 28], we identified three types of social back up: emotional, functional and informational support. These results are presented in the following sections.

Emotional support

Emotional support includes the provision of care, trust, reassurance, and companionship. The participants in this study described the powerful emotional support they had received from their husbands and from some other members of their close family unit at different stages of the affliction (e.g. from their mothers or siblings). The support of these family members helped them continue their fears under control and continue taking intendance of other family members such equally children.

During the interviews, some participants recalled the moment they talked with their husband, as reported by S. and K., or informed their parents, as reported by H., and received immediate emotional support (See Extracts 1,2 and 3).

Excerpt one. Southward. (32 years quondam): "My husband was always trying to be strong and supportive of me, and he never let me feel that I had cancer."

Extract 2. G. (42 years erstwhile): My husband has become closer to me and supported me a lot during my handling period."

Excerpt 3. H. (33 years old): "When I got the diagnosis result, I directly went to my parents' house even though my specialist dr. had asked me not to tell my family about my status so that information technology wouldn't bear upon me negatively, I couldn't avoid telling them. I feel comfortable when I see my parents and I forget that I am ill, but when I am at domicile, I feel that I will dice at that place and then! I feel much safer when I am with people!"

This extract clearly shows the emotional conflict faced by women regarding hiding the cancer diagnosis from family members or communicating information technology to them. This disharmonize is present in the Palestinian society (and here voiced by the dr.) and related to fear of the social stigma associated with the cultural beliefs about cancer [13].

Another example of emotional support provided past a family member is illustrated by R., who was 20 years old when she was diagnosed with cancer and was helped past her brother (See Extract 4).

Extract 4. R. (22 years quondam): "[My brother] was always with me during all the treatment stages. I used to share all my thoughts and feelings with him; he e'er fabricated me stronger and supported me all the way through. I always had certain fears regarding the handling and nearly the things that I used to hear, but he always advised me not to listen to anyone."

In the case of T. (42 years onetime), her mother was very supportive of her emotionally, because she had lived the aforementioned experience (Come across Extract 5).

Extract 5. T. (42 years old): "My female parent talks with me a lot to support me; as 12 years ago, she had cancer and survived."

In a different case, Sa., a 56-year old nurse, initially refused chemotherapy because she was concerned about the side effects, merely later changed her listen cheers to the support and insistence of her husband to follow the treatment (See Excerpt 6).

Extract 6. Sa. (56 years old): "In the get-go, I refused chemotherapy, but with the assistance of my husband, he convinced me."

Other interviews show the role played by family members in limiting loneliness and isolation for the participants. The majority of the participants reported that they were more inclined to "isolate" themselves from others mainly considering they were afraid of the compassion that some people may feel towards them and also of the many questions about their illness; this bothered them very much, specially after surgery and the outset of chemotherapy. Husbands or friends helped them to leave such isolation, by encouraging them to get out of the house and communicate with people (Run into Extract 7 & 8).

Extract 7. M. (38 years old): "My husband was very kind with me and tried to make me go out, especially when he noticed that I had started to sit lone and call up nigh my situation."

Extract 8. G. (56 years old): "I got abroad from people for two years and became isolated. Merely a group of friends supported me through recreation programs and holding awareness workshops on the illness and treatment."

Some participants reported that interacting with people helped them to have a positive and optimistic view on life (See Extract 9).

Extract 9. Sn. (46 years former): "I felt people's love for me and everybody was asking almost me to make sure I was fine."

Some participants, as in S.'s instance (32 years old), reported that their families had tried to support them by advising them to "ignore the disease" and alive as normally every bit possible, in accordance with a personal conventionalities that this could assistance them overcome the difficulties that might occur in the class of the affliction. Thus these families hid their feelings of anxiety and fright, and avoided talking almost negative thoughts, to avoid any outpouring of sympathy and give them "strength"—particularly during the treatment flow. At the same time, some participants were able to hide their fears, anxieties, and despair from their family unit and tried to alive every bit normally as possible (Come across Extract ten).

Extract 10. M. (38 years old): "My family did not prove whatever reaction in front of me; and always told me: "We hope that God will make you recover" and tried to support me all the time. And my children tried to bargain with me in a normal way every bit if I was not ill."

This department provided bear witness of the emotional back up provided by husbands, close family members and friends in their attempt to provide the participants with emotional remainder, reassurance, and assistance to avoid isolation and loneliness.

Functional back up

Functional support includes the practical aid that the cancer patients receive in terms of fiscal support, omnipresence during treatment or aid with domestic chores and childcare. The participants in this study reported that they had informed their families nearly having breast cancer, particularly since they needed someone to be with their children and take intendance of them.

An instance of functional back up is provided by A., a 37 year old working adult female with a Master's degree and a mother of 5 with an advanced phase of the affliction, who has been helped past her hubby in domestic and family unit care (See Extract xi).

Extract 11. A. (37 years one-time):"My family was very supportive of me in fighting this disease especially my husband, who took total responsibility of the house."

South. (36 years one-time) decided to inform her sister, who was living in Jordan, well-nigh her status, so that she could come to the OPT to take care of her children while she was receiving treatment (See Excerpt 12).

Extract 12. Due south. (36 years old): "I told my sister who is living in Hashemite kingdom of jordan to come here at the time of the surgery to sit with my children."

In the present report, all the participants were usually accompanied by family members to handling sessions or to medical visits (Meet Extract xiii).

Extract xiii. Sh. (32 years old): "My husband was very cooperative and supportive of me and accompanied me to all tests and treatment sessions…he didn't get out me alone."

In the occupied Palestinian territory it is a routine practice for at least one family member to accompany a patient during chemotherapy sessions, particularly considering of the side effects which the patient may feel after each session, such equally airsickness and fatigue.

Well-nigh participants reported receiving financial back up from their families. In the majority of cases however, husbands in detail assumed all financial responsibilities. The participants, most of whom were housewives, were economically dependent either on their husband or a close family member.

In this study, one participant (B., 53 years one-time) described her husband's uncommonly farthermost reaction to her status. According to B., her husband abandoned her subsequently he plant out that she had been diagnosed with breast cancer. Withal, she was extremely grateful to her brother for supporting her financially and emotionally (See Extract 14).

Extract 14. B. (53 years one-time): "My husband does not know annihilation about me, or where I get handling and who is post-obit-upwards my instance closely until at present. Since I found out I had cancer he has been telling me: "I don't believe you are ill"… this has been his reaction since the showtime… our union is over! He left me… he wants me to be just as I was earlier in the same image he still keeps in his mind. I run into him merely once a calendar month and there is no advice between us! (…) My brother supported me financially and emotionally."

Merely i case of marriage breakdown due to cancer has been reported in the present study; however, similar cases take been documented in Arab countries [44].

Returning to the question of financial support, Ba., a 48 year-old single woman who lives with her family and is responsible for supporting her family financially, has been facing a difficult financial problem since the beginning of her cancer treatment, when she was regularly absent from her work, and her employer stopped paying her salary (See Extracts 15 & 16).

Extract fifteen. Ba. (48 years one-time): "My colleagues at piece of work supported me a lot. During my treatment period, the company where I piece of work stopped my salary considering I was absent-minded from work."

Excerpt 16. N. (49 years old): "Friends supported me psychologically more than than my family."

N., a single adult female who lived alone in her own house, could not tell even her father that she had cancer because she was afraid that the news might affect his health. And her mother was dead. N. stated that she had received emotional and social support from her friends and this had helped her in facing the disease.

Informational back up

The study participants received supportive information from several sources: doctors, mainly oncologists and surgeons; family or relatives, specially if there was someone working in the medical field; breast cancer survivors and other cancer patients.

In this context, the participants indicated that they oftentimes asked for a 2nd opinion before starting a treatment programme proposed past the md. They consulted other doctors to get more information almost their health status, and specific details nigh the therapeutic steps which had to exist taken. These medical consultations were fabricated both locally and abroad (due east.g. in other Arab countries mainly Jordan, or in Europe or the United states of america), particularly if they had relatives or friends living outside the OPT (See Extract 17).

Excerpt 17. Thousand. (42 years old): "It is true that the doctor told me everything, but honestly it was non enough for me, I travelled to Jordan and consulted doctors at Al-Hussein Cancer; and what they told me was identical to what my doctor in the West Banking concern had told me."

It appears that the chief reason for participants to seek outside information was their need to obtain clearer and more detailed information almost their health condition and to confirm the treatment recommendation. In some cases the reason was to verify the surgeon'due south decision to perform a mastectomy.

However, not all the participants wanted to obtain the information past themselves. Some women asked their husbands to communicate with the doctors on their behalf, preferring non to hear anything related to the illness, every bit reported by Southward. (36 years old) who asked the doctor to deliver the diagnosis result to her married man as she did non desire to receive it herself. Some of the participants asserted that this gave them "strength" every bit they received the back up and assist of their families (See Extracts eighteen, 19, xx).

Extract 18. South. (36 years old): "I didn't want them to tell me over the telephone, nor to ask me to go to the center to get the news. Information technology was amend for me that they communicate with my married man."… "So, my husband is trying to know everything regarding my instance earlier I do, and he follows up on my health condition more than I do."

Excerpt nineteen. D. (67 years old): "He (blood brother-in-law) simply told me that I had cancer and that my breast had to be removed! No other way would accept been better to be informed well-nigh my condition since my brother-in-police force is a brother to me."

Extract xx. Sa. (56 years old): "I was terrified by the result; my married man followed-up on everything and information technology was skilful that he informed me."

These information propose that in the occupied Palestinian territory the family plays a key role in medical consultations and negotiates with the doctor regarding the manner in which the patient is informed, or not, about the diagnosis.

Other sources of information include internet searches to learn more about the disease in general or its handling and side effects, and advice on coming together the nutritional needs of cancer patients, particularly during the chemotherapy flow (See Extracts 21 & 22).

Extract 21. Y. (35 years old): "[I read] medical brochures and I also listened to other people's experiences. I did not know anything about the disease and I needed at present to know almost its symptoms and treatment."

Excerpt 22. Nd. (49 years old): "I use the internet to read about salubrious food for cancer patients as well as the stages of treatment."

In the following extracts we focus on the difficulties that cancer patients face in getting information from cyberspace websites. Some websites, especially those in the Standard arabic language, incorporate inaccurate or outdated information. This makes finding accurate and upward-to-date online information almost cancer a peachy challenge for many patients and their families. Some participants reported receiving information from books or brochures, or from other patients. Nonetheless, obtaining information is not always considered a good thing by participants; it might, in some cases, have negative consequences (run into Excerpt 23).

Extract 23. L. (41 years erstwhile): "I used to inquire a lot of patients most their cases and my status deteriorated; later on that I decided to not ask anyone."

L. clearly stated that after asking patients about their feel with the disease for some time, she stopped doing so as she found that information technology had a negative bear upon on her and increased her fearfulness and anxiety about the disease symptoms and side effects of handling and accompanying hurting and weakness.

In this department we showed that accessing informational support can be quite challenging in the OPT since the information from websites in Standard arabic language is not always reliable and extra try is required to double-bank check medical advice (e.g. by travelling abroad). The family also plays a key part in obtaining informational back up, by mediating communication with doctors. Contact with chest cancer patients and survivors is an additional source of supporting data, with however a possible negative touch on in terms of emotional coping [17]. Interviewees such as 50. deliberately avoided interactions with other patients as a way to protect themselves from making parallels that might harm their promise and psychological well-being.

Discussion

There is a lack of research conducted in the occupied Palestinian territory exploring how patients cope with cancer. While further studies are needed, this inquiry can exist seen as a contribution towards filling that gap by giving vox to a hardly considered population: Arab-Palestinian women with chest cancer. Given the nature of qualitative enquiry, we practise not aim to generalize results only to contribute to the situated understanding of cancer coping strategies inside the local context of the occupied Palestinian territory.

Our study describes the significant role of social relations as the master resources for women with breast cancer to gain support and cope with their disease. Members of the close family—the husband in particular—are reported to be the nearly supportive social sources. The written report documented the three main types of support (emotional, functional and informational) provided through social relations. Emotional support includes the provision of reassurance, balance, companionship; functional support consists of financial assistance, help with domestic work and childcare, applied assistance and attendance during treatments; advisory support includes information about health conditions, treatments and side furnishings and nutritional communication.

In all three types of support, the close family, and the husband in particular, plays a key role. This is partly linked to the young age of the interviewees (older patients could, for example, have indicated their children as a source of support). In the literature on Arab countries, however, the role of the husband as a companion and caregiver of women with breast cancer seems to be rather controversial. Studies on chest cancer patients from eastern countries have reported cases of marriage breakdown [44–46], picturing the hubby as a not-supportive source. In the nowadays report, notwithstanding, a union breakup was documented in only ane of 36 cases. Although circumspection must be taken in interpreting a qualitative written report, this finding may indicate a situation in the occupied Palestinian territory more similar to what has been institute in non-Arab countries in the Middle Eastward region such every bit Iran and Turkey [47, 48].

The centrality of the husband's support may be due to the restrictions imposed past the Israeli occupation on the mobility of Arab-Palestinian people and the beingness of the Separation Wall [xiii, 49]. These difficulties obstruct access to both the health care organization and the social back up networks such equally the extended family and other members of the nuclear family unit.

Every Arab-Palestinian citizen, who moves in the occupied Jerusalem or the West Bank, would become through military checkpoints for inspection. Going through these checkpoints may have several hours and this can sometimes lead to complications in their condition. Under these circumstances, a lot of people exercise not leave their homes unless in extreme necessity as they feel unsafe and are forced to wait for a long fourth dimension at checkpoints [thirteen].

In Western countries about 80–ninety% of patients are informed of the oncological diagnosis, while in other cultural contexts the percentages are much lower (betwixt 0 and 50%) [50, 51].

In contrast to the literature focused on Western societies and civilization, where in that location is more emphasis on individualistic frames of reference and more concern for private autonomy, studies from the Heart East and E Asian contexts give greater emphasis to the role of the family and to commonage decision-making that as well influences the communicative practices of a cancer diagnosis [50].

Conclusions

Given the limitations that characterize the access to health intendance in the OPT, Arab-Palestinian women rely on the immediate family to handle emotional, informational and practical needs, while respecting and perpetuating the cultural norm that encourages them to hibernate their illness from the social environment. In the occupied Palestinian territory, women with breast cancer therefore experience multiple difficulties: first, they live a disruptive feel because of the oncological disease; second, they notice themselves in a historical and political context that makes access to cancer care peculiarly complicated; 3rd, they are in a sociocultural context that stigmatizes cancer, encourages its concealment and promotes adherence to traditional customs. Studies on attitudes towards cancer among Arab people in the Middle East reveal prevalent fear, embarrassment, cultural barriers related to modesty and social stigma, and fatalistic beliefs regarding causes and outcomes of cancer [xiii, 24–26, 49]. In this context, the shut family becomes a fundamental resources for coping and a relational space that in turn mediates connections with others, including doctors, acting as a "proxy" betwixt the patient and the social environs. Given the nature of qualitative research, we do non aim to generalize results, but to contribute to the situated agreement of coping resources within the local context of the OPT, a unique situation of enduring disharmonize and bereft healthcare. Farther studies using unlike analytical approaches may verify the extension of these findings to the wider OPT population.

Acknowledgments

The authors thank all of the patients who participated in this study and shared their experiences.

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