The relationship of family support with decision-making duration in cancer patient to perform a mastectomy

Abstract

BACKGROUND:

Cancer is a disease caused by abnormal growth of body cells that turn malignant and continue to grow uncontrollably. One of the treatments for breast cancer is mastectomy. The quickness of decision-making determines the survival rate of prognosis patients.

OBJECTIVE:

This study aimed to determine the relationship of family support with decision-making duration in cancer patients to perform a mastectomy.

METHODS:

An analytic observation method with cross-sectional design. The samples were taken by purposive sampling method with 50 samples of breast cancer patients. Data collected include age, last level of education, marital status, profession, stage of cancer during mastectomy, family support score, and decision-making duration to perform a mastectomy. The data analyzed with the Kruskal-Wallis bivariate test.

RESULTS:

The bivariate test showed the relationship of family support (p = 0.002) with decision-making duration in breast cancer patients to perform a mastectomy.

CONCLUSION:

There is a relationship between family support with decision-making duration in breast cancer patients to perform a mastectomy.

1. Introduction

Cancer is one of the deadly diseases in the world caused by an abnormal growth of the cells of the body that turn malignant, the malignant continuing to grow uncontrolled spread to many parts of the body. Malignant cells could not be dead, but continuing to grow is invasive and urged normal cells to cause death [1]. Cancer disease made it the most feared, especially by women in Indonesia and there is even around the world is breast cancer. In the year 2017, it is estimated that 257.710 new cases of invasive breast cancer have been diagnosed in women all over the world [2]. In the various national prevalence of cancer to those Indonesia 2013 of 1,4% or estimated as many as 347.792 ones. Cancer prevalence in 2018 also in East Java has increased from the year 2013 and occupies the highest order numbers even in Indonesia [3]. The main purpose of breast cancer therapy is to remove cancer cells and determine the stadium of breast cancer. The surgical therapy that may be selected is mastectomy. Mastectomy has often taken as a method of healing because it proved to have healing largest standard [2].

The decision-making process to undergo the act of mastectomy is important. Speed decision-making determines prognosis breast cancer patient survival rate. Time and the decision-making process differed between one patient with the other. The discovery of a study that many patients take time to recover first from a state of shock from diagnosis before they can make decisions for therapy to be taken [4], while the longer decision making then cancer cells continue to grow. Doubling time cancer cells is 30 days to the kind of fast-growing and 90 days to the kind of slow-growing, and hopefully less than the time the patient is able to decide who will run, therapy efforts to get a good prognosis.

Many factors are considered in the decision-making process to impact the time it takes a patient to approve the action of the mastectomy to be performed. One of the factors that might affect this level of family encouragement is towards patients to discuss judge to immediately started the therapies [5]. Joint decision-making is an essential component of care centered on patients and health outcomes associated with increased. Family members played an important role in giving care for most cancer patients [6] and commonly attended when cancer treatment decisions were made [7]. Some evidence from research that examines the decision-making process at the end of life shows that a specific ethnic group, the Asian and Hispanic, might prefer more decision-making centered on families than white people [6].

This study was conducted to obtain the family support of the decision-making long breast cancer patients to undergo mastectomy. The results of this study can add information to health workers to handle patients at the holistic comprehensive in various aspects.

2. Method

2.1. Research location

This research was conducted at the oncology department at X hospital Surabaya. Research locations were chosen because it is one type of a hospital in east java that can give medical service specialists and sub-specialist. Hospital is set apart as a referral system highest in it had complete service to handle cancer patients.

2.2. Type and sources of data

The data were drawn in this research are the demographic data (age, last education, work, married status, and stage of cancer at the time of mastectomy), family support of the patients will be measured by questionnaire, and the duration of patient decision-making to perform a mastectomy. The data taken was primary data from patients using a questionnaire. Included in this research is 50 breast cancer patients, taken using a technique sampling purposive.

2.3. Data collection technique

Technique preceded the data with submission of conduct research into the hospital, approved then after the data was undertaken. Before distributed the questionnaire, researchers will explain research objectives and ask the patient, also interview the patients first is it right on inclusion sample as follows:

Female;

Age of 20–60 years, age at risk of breast cancer;

Patient with stage I–III breast cancer who had undergone mastectomy;

Patient with stage I–III breast cancer who had decided to undergo mastectomy;

The patient was willing to be the research respondent.

As for the criteria, the exclusion sample is patients who have had mastectomy over five years because skeptically, there is uncertainty from has happened the process of adapting. After all, criteria are met, and patients agree to be respondents, then the researcher will then distribute the questionnaire. The data were drawn in the form of demographic, including age, education last, work, married status, and stadium cancer when they did mastectomy. Family support considered use questionnaire family functioning questionnaire (FF-SIL) with five alternative answers Likert scale contains 14 questions. A score of family support obtained by counting the number of the score at questionnaire family supports the result of which divided into four categories very weak to score 14–27, weak to score 28–42, enough to score 43–56, and good to score 57–70. The duration of the decision-making to undergo mastectomy was categorized into three, including long (more than two months), moderate (1–2 months), and short (0–1 months). The data obtained would be analyzed using the Kruskal-Wallis bivariate test.

3. Result

This study examined the effect of breast cancer patients’ knowledge on the duration of decision-making to undergo mastectomy. The majority of respondents’ ages were in the early elderly phase, aged 46–55 years (64%). Most respondents’ last education was senior high school (48%). Almost all of the respondents were married (98%), and the majority occupations were housewives (58%). The majority of respondents were in stage II when undergone mastectomy (54%) (Table 1).

Table 1

Demographic data of respondents

Characteristics		Frequency
		n	%
Age (years)	Early adulthood (26–35)	2	4
	Late adulthood (36–45)	16	32
	Early elderly (46–55)	32	64
Total		50	100
Last education	Elementary school	5	10
	Junior high school	8	16
	Senior high school	24	48
	Vocational high school	5	10
	College	8	16
Total		50	100
Marital status	Married	49	98
	Divorced	1	2
Total		50	100
Occupation	Private employee (Swasta)	13	26
	Housewife	29	58
	Civil servant	6	12
	Farmer	1	2
	Teacher	1	2
Total		50	100
Cancer stage	I	7	14
during surgery	II	27	54
	III	16	32
Total		50	100

Table 2

The frequency distribution of family support

Characteristic		n	%
Family support	Very weak	0	0
	Weak	13	26
	Enough	21	42
	Good	16	32
Total		50	100

The distribution of family support included the very weak category was none, the weak category was 13 people (26%), enough category was 21 people (42%), and the good category was 16 people (32%) (Table 2).

Table 3

The frequency distribution of the duration of the decision-making

Characteristics		Frequency
		n	%
The duration of	Long	24	48
decision-making	Moderate	8	16
to undergo mastectomy	Short	18	36
Total		50	100

The distribution of the duration of decision-making to undergo mastectomy consisted of 24 respondents (48%) who decided in a long time, 8 people (16%) decided in moderate time, and 18 people (36%) decided in a short time (Table 3).

Table 4

Cross-tabulation between family support and duration of decision-making to undergo mastectomy

		The duration of the decision-making
		Long	Moderate	Short	Total
The family support	Very weak	0	0	0	0
	%	0%	0%	0%	0%
	Weak	11	0	2	13
	%	22%	0%	4%	26%
	Enough	10	6	5	21
	%	20%	12%	10%	42%
	Good	3	2	11	16
	%	6%	4%	22%	32%
Total		24	8	18	50
%		48%	16%	36%	100%

None of the respondents had very weak family support (0%) on the family support variables. The respondents who had weak family support and needed a long time in decision-making to undergo mastectomy were 11 people (22%). None of the respondents had weak family support and needed moderate time in decision-making to undergo mastectomy (0%). Furthermore, the respondents who had weak family support and needed a short time in decision-making to undergo mastectomy were two people (4%). The respondents who had enough family support and needed a long time in decision-making to undergo mastectomy were ten people (20%). The respondents who had enough family support and needed moderate time in decision-making to undergo mastectomy were six people (12%). Moreover, the respondents who had enough family support and needed a short time in decision-making to undergo mastectomy were five people (10%). The respondents who had good family support and needed a long time in decision-making to undergo mastectomy were three people (6%). The respondents who had good family support and needed moderate time in decision-making to undergo mastectomy were two people (4%). Furthermore, the respondents who had good family support and needed a short time in decision-making to undergo mastectomy were 11 people (22%) (Table 4).

Table 5

The relationship of family support on duration of decision-making to undergo mastectomy

Variable	P-value
The effect of family support on duration of decision-making to undergo mastectomy	0.002*

*p < 0.05.

Based on the bivariate analysis test results, it was found that there were significant results on the relation of family support on the duration of patient decision-making to undergo mastectomy (Table 5).

4. Discussion

Based on the data analysis, it was found that family support related to the duration of decision-making to undergo mastectomy with a P-value = 0.002. One study described that patients who received support from their families were less likely to delay making treatment decisions, [8] while patients who did not have social support from family members and partners were more likely to delay the treatment decision [9]. According to the study results, the majority of respondents who received low-income family support needed a longer decision-making time to undergo a mastectomy, while those who received moderate and good family support had a shorter decision-making time to undergo mastectomy. One study showed that most patients seek medical care after persuasion and encouragement from their families. When individuals disclose their symptoms to someone close to them, they may receive encouragement and assistance to seek medical care and be less likely to delay the treatment decision. A high level of family support could help patients, encouraged them to express their symptoms, and provided encouragement and assistance to seek medical care [10]. Good family support motivated patients to recover, increased self-confidence, and finally could adhere to the planned therapy without significant obstacles. However, some studies stated no correlation between family support and the duration of breast cancer treatment decision-making [11]. Further research was needed to determine optimal patient education and maximize the role of the family in decision-making in this issue. Indonesia was a country that still upholds family decisions to be the final decision in various matters. Many aspects still could be explored from this variable.

The potential limitation of this study was the small sample study. Further study was needed to access additional information on this issue. The sampling method (purposive) was another limitation affecting the generalizability of all studies.

5. Conclusion

In conclusion, this study has determined a relationship of family support with decision-making duration in breast cancer patients to perform mastectomy withp < 0.05.