Theme 1 Mothers are lost in chaos
Unable to deal with the shock of cancer
This is the beginning of a new trajectory for the family when the diagnosis is conveyed. At that moment, mothers were under the information bombardment and felt blindsided by the huge amount of information they received about the diagnosis and the treatment options. It is difficult to deal with the shock of breast cancer for mothers who have never had contact with breast cancer. Therefore, mothers tend to choose to deal with devastating crises (such as diagnosis/treatment and marital crisis) under the shock of cancer and overlook the relationship of mother and daughter. Some mothers disclosed that their adolescent daughters were acutely aware of changes in the family atmosphere when they were not ready, this leaves mothers feeling unprepared.
P2 At that time, I didn't know how serious my illness was, I felt unsure about how to approach the issue. I'm confused! I was busy with my treatment and financial problems, which limited my communication with my daughter.
P14 Of course, for a while after my diagnosis I was depressed about breast cancer. To tell you the truth, I don’t know how clear I am about the results and don't have the energy to think about my relationship with my daughter.
Powerlessness of the uncertainty about the life span
The diagnosis of breast cancer is a great blow for mothers, they often associate cancer with death. Most mothers spoke about their likely limited life expectancy, and even if the newer treatments could extend her life, it would never be enough time. Mother plays a unique role in her daughter's life. They hope to give their daughter some life advice on her daughter's life path and stop their daughters when their daughters may enter the wrong crowed. But breast cancer has hindered mother's original role, they can't interact fully with their daughter at a limited time. Most of the mothers interviewed expressed their concerns and powerless about mortality, recurrence, and not seeing children grow up. The interaction between mother and daughter is hindered by mother’s uncertainty about the future (sense of time) and their worry for their daughter’s future.
P6 I'm confused about the future. I'm still adjusting myself. I don't know how long I can stay with my daughter and how to face her. Maybe I still need time to tidy up myself.
P19 The thing I think that makes me most upset is her (my daughter). I could talk about me and be like, “Yeah, it’s me. I’m going to die one day.” But it’s her (my daughter) that makes me the most upset, I think.
P1 I just have this fear that ... if something happens in the next couple years.
Confused about how to respond to daughter's curiosity
Mothers have a trusting relationship with their daughters due to gender homogeneity. Evidence has shown that mothers are the preferred source of sexual knowledge and discussion for adolescent girls worldwide. However, because of the specificity of breast cancer, mothers with breast cancer should not only protect her daughter from the impact of her cancer, but also protect her daughter from the impact of mother’s crippled breast. It is worth noting that adolescent girls are always curious about their physical changes,but most mothers are uncertainty about how to talk with their children about sexual issues (which is taboo in some cultures), and they to tend to limit the discussion to safe topics. And give to the role that mothers play in implicitly influencing daughters’ views on secondary sexual characteristics (breasts), it is likely that more explicit communication about breast cancer could also impact aspects of adolescent daughters’ body image. Many mothers hope to communicate their physical condition and treatment with their daughters, but they feel unsure about how to talk to their child and how much information to share with them, which makes them confused and tangled. The practical and emotional challenges of communicating with daughter complicate their mother–daughter interactions, they were aware they lacked a scarcity of evidence-based guideline to manage, but often were unsure how to do so.
P2 I feel puzzled. Actually, I want to communicate with her (about breast cancer), but I don't know how to do. My daughter is in puberty and secretly told me that her breasts are changing. She was full of curiosity about breasts and told me that her classmates had put on a vest. I dare not let her see my breast because I had a mastectomy. I'm afraid it will cause psychological shadow to her. I'm walking on eggshells!
P14 I think I should tell my daughter about my illness, but I'm struggling with what method to tell her. I didn't get any professional help in communicating with my daughter, nor did I find any information. I hope to get guidance on how to communicate and make it easier for children to accept the facts. This requires children's cooperation, and mainly depends on adults to guide. This part is still lacking, and no one gives me relevant guidance.
Theme 2 Mothers struggle for balance
Protect daughter or let her be independent
The influence of breast cancer makes these mothers to change the way of interaction with their daughters. They struggle between their daughter's independence or protection, trying to maintain a balance. After suffering from breast cancer, the mother struggled to hide or tell her daughter the truth of the disease. On the one hand, they are worried that their daughters will have a psychological burden when they know it. On the other hand, they feel they can't hide it and worried that their children will become more anxious when they don't know the truth. And factual explanation can promote daughters to become independent and get emotional support from their daughter, which is a way to mutually share strength. Most mothers(n=18) with breast cancer say that she will tell her daughter when she can't hide, or at some point, observe her daughter’s reaction and decide whether to tell her daughter about her condition.
Therefore, mothers tend to pay more careful attention to their daughter’s behavior and language, but it is not without difficulty for mothers with breast cancer.
P8 I was afraid that telling her my illness would make her have a psychological burden, so I didn't tell her at first, but later I found that she was more worried. She guessed every day and was very upset. Then I decided to tell her that I chose to tell her when her school (enrollment and school selection) had been set.
P13 I didn't let my daughter go to the hospital before the treatment plan was decided. I don't want to cause psychological shadow to her. But my hair will fall off after chemotherapy. I can't hide it. I had to tell my daughter about my condition.
P20 I think it’s better to show your down sides instead of trying to be strong all the time. I’ll need my daughter’s help, and I can make it with the courage she gives me. But I think she is still young. First, she doesn't know what cancer is. Second, tell her my condition may make her lose happiness, which is not what I want to see. I did not want to say too much to “scare them off”, yet wanted to give their daughters knowledge to make them independent, and I'm looking for a chance to let her understand my condition.
As a mother or a patient
For those mothers whose daughters are minors, being a mother is a hard activity, such as volunteering at their daughter’s school, going on field trips, driving children to and from daughters’ school, and being present in daily life. Many participants(n=16) expressed the importance of doing everything that they had previously done. But for mothers with breast cancer this was not always easy and required some modifications to daily life. As some mothers described, even if they suffer from cancer, even if they suffer from treatment pain, they still insist on doing housework and maintaining their children's daily life when their physical strength allows, hoping to minimize the impact on their daughters' study and life and reduce the burden on others. However, this was not always easy, they’ve got to rest all day to recover from doing so much other stuff or have to overdraft their physical strength. Therefore, in the process of illness, the mother must make some efforts to adjust and balance the relationship between mother and patient, to help daughters recognize their mother won’t be able to do this and that for a while. Even though this is full of challenges, it is conducive to the development of mother's physical condition in a good direction.
P8 My daughter still asked me to send her to school and help her carry heavy things like I did when I was not ill, but sometimes my body can't bear it. Maybe my daughter will be more considerate to me when she realizes my condition and won't make unreasonable demands on me. I was thinking about whether to show my daughter my wound, which might hit her, but let her know a little about my condition, maybe I wouldn't be so tired.
P 12 I think if I were on my own, if I were a single person without kids, this would be easier for me to deal with because the most difficult part is dealing with the kids. I still insist on housework and taking care of the children's daily life even if I am ill, I want to give her the impression that I am still mom.
Theme 3 Mothers are immersed in guilt
Increasing risk of cancer for daughters
Daughters can share the mother’s genetic variations and, as such, disease risk. The presence of a hereditary cancer predisposition can make mothers feel guilty. And mothers felt exacerbate guilty when the daughter expressed blame to her mother for having passed along her increased risk. It’s result in dysfunctional mother-daughter interactions. Though mothers understood that their risk or disease was not their fault and not within their control, they felt responsible for their daughter’s disease risk. The guilt as an emotional, it’s a challenge for breast cancer mother to use intellectual to overcome guilt to loosen mother daughter interaction.
P16 I'm very worried that my daughter will get breast cancer. Because my breast cancer can cause my daughter to have a higher rate of disease than others. Sometimes, when I see my daughter, I feel guilty for her because I think her future trajectory will have some bad changes because of my breast cancer.
P4 I'm very afraid that this disease will be passed on to my daughter. I'm very anxious.
Influencing the development of daughter
Mothers play a special and important role in a family and their breast cancer affects the development of the whole family, especially their daughters. They feel sadness, guilty and worry because they can't perform their responsibilities of raising children well, and they often think they have become a "bad mother". The adverse reactions of postoperative and radiotherapy have seriously affected the image of breast cancer patients, which may also lead to psychological problems such as low self-esteem and self-doubt in the daughter of the patient. The experience of losing their mother will also affect adolescent daughters’ emotions and personality. In addition, as adolescent daughters are in an important stage of learning, mothers are very worried that their diseases will put pressure on their children and affect their learning. For mothers was hitting by breast cancer, dealing with these intertwined emotions is a huge challenge.
P6 I used to take her swimming, but I can't take her anymore. Once my daughter came back and told me that when her classmates saw me her classmates all looked at us with strange eyes, and some even covered their mouths and smiled. I'm worried that my illness will affect my daughter's psychology and she will feel inferior. I don't think I'm a good mother.
P14 My daughter's grades are always ahead in the class, but I didn't help her with her homework after I was ill, so the teacher will find mistakes when checking her homework. Her teacher will criticize her and she will be unhappy when she comes home. I feel sad about it…
Bring burden to daughter
Mothers believe that breast cancer as a family genetic disease will affect their daughter's marriage, and their daughter's future partner will be estranged from her because she carries breast cancer genes. Some adolescent daughters even express that I’m never getting married and I know I’m gonna get cancer. In addition, their daughters, who are at high risk for breast cancer, need to pay attention to diet and physical examination, which may impose additional burden on their daughter's daily life. The enormous financial burden to families is also an important reason why mothers with breast cancer feel guilty. They feel that their illness has reduced the quality of life of the entire family, including their daughter. The mothers felt guilty about the burden they had placed on their daughter increase the difficulty of getting along with her daughter.
P21 My daughter kind of holds me responsible both for her cancer and marriage. I'm very worried... my breast cancer is bad for my daughter to get married. Her partner may be estranged from her.
P12 Our savings had to be used for treatment and bear the education and living expenses of our two children. Now I spend most of my money on cancer treatment, there will be no way to guarantee the future quality of life of my children.