The Supportive Care of Saudi Women with Breast Cancer

Abstract

Supportive Care Needs of Saudi Women with Breast Cancer: A Mixed Methods Convergent Design Study Women with breast cancer can experience a range of informational, psychological, and physical supportive care needs at different stages of the cancer journey. There is limited insight and understanding of the breast cancer experience and supportive care needs from the perspective of the Middle East and North Africa (MENA), region and specifically Saudi Arabian women. Further, it is less clear which needs are most pressing to women, and at what point in the care pathway these needs arise. In this study, I aimed to fill that gap by exploring the supportive care needs of women in Saudi Arabia and evaluating the applicability of a supportive care framework to determine its relevance to the care of women with breast cancer in Saudi Arabia and more broadly the MENA region. Methods: A mixed methods exploratory convergent design was used. Cross-sectional surveys were applied, including the Supportive Care Needs Survey short form 34 (SCNS-SF34 – Arabic version), with eight supplementary questions that were specific to breast cancer patients, plus 15 additional items derived from the MENA region scoping review conducted by the researcher. All items were mapped against the identified supportive care needs framework and modified based on the scoping review findings. Then, the instruments were piloted to assess face validity and subsequently administered to Saudi women with breast cancer (n=85) recruited from one specialist cancer centre. Descriptive statistics were used, followed by Rasch modelling to estimate reliability, validity and dimensionality. Semi-structured interviews with a maximum variation sub- sample of Saudi women (n=20) were analysed using the framework method. Joint display integration was used to enhance the findings. Results: Physical needs (median=3.75, IQR=1.50), health system informational needs (median=3.67, IQR=1.67), and psychological needs (median=3.60, IQR=1.85) were ranked highest, whereas intimacy-related needs (median=2.22, IQR=1.6) were the lowest ranked domain. Correlations of supportive care needs with demographics showed significant associations with employment status, hormonal therapy, and age. Cognitive needs were significantly higher in younger women, while receiving hormonal therapy was significantly associated with higher spiritual and family-related needs. Also, employed women showed less need for physical and practical support and patientclinician communication. Interview findings suggested expanded results in most domains and showed that needs differ at various points in the cancer journey. Chemotherapy treatment specifically was identified as the most difficult period, requiring the most support. Joint display integration was used to synthesise findings and showed nuanced insights across most of the domains, such as how women still face social stigma, and the important role of religion in their cancer journey. These insights highlight the need to redefine supportive care needs and develop a tailored, culturally specific framework to fit the context of the MENA region. Conclusion: The findings from the scoping review confirm that women’s unique needs in the MENA region require redefining and redevelopment of the Paterson framework and adaptation to this context. The mixed-methods design provided rich evidence that illuminated women's needs and could contribute to informing the design of culturally specific supportive care interventions for Saudi Arabian women and provide recommendations for service improvement.