The Decision-Making Journey of Malaysian Women with Early Breast Cancer: A Qualitative Study


Background: The survival outcomes for women presenting with early breast cancer are influenced by treatmentdecisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early,many refuse treatment for complementary therapy.
Objective: This study aimed to explore the decision makingexperiences of women with early breast cancer. Materials and
Methods: A qualitative study using individualin-depth interviews was conducted to capture the decision making process of women with early breast cancerin Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eightparticipants consented and were interviewed using a semi-structured interview guide. These women were recruitedfrom a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decisionsupport framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribedand analysed using a thematic approach.
Results: We identified four phases in the decision-making process ofwomen with early breast cancer: discovery (pre-diagnosis); confirmatory (‘receiving bad news’); deliberation;and decision (making a decision). These phases ranged from when women first discovered abnormalities in theirbreasts to them making final surgical treatment decisions. Information was vital in guiding these women. Supportfrom family members, friends, healthcare professionals as well as survivors also has an influencing role. However,the final say on treatment decision was from themselves.
Conclusions: The treatment decision for women withearly breast cancer in Malaysia is a result of information they gather on their decision making journey. Thisjourney starts with diagnosis. The women’s spouses, friends, family members and healthcare professionals playdifferent roles as information providers and supporters at different stages of treatment decisions. However, thefinal treatment decision is influenced mainly by women’s own experiences, knowledge and understanding.