Nurses' Support for Women with Breast Cancer Undergoing Chemotherapy in Indonesia: A Qualitative Study
Keywords:
Breast cancer, Chemotherapy, Holistic nursing, Indonesia, Supportive CareAbstract
Women with breast cancer experience multiple biopsychosocial and spiritual challenges during chemotherapy, yet supportive care from nurses in Indonesia remains underexplored. This study aimed to explore nurses' experiences in providing supportive care to women with breast cancer undergoing chemotherapy in Indonesia. A descriptive qualitative design was applied. Six oncology nurses were recruited through purposive sampling in a referral hospital in Bandung, Indonesia. Data were collected using semi-structured interviews and were analyzed thematically following SRQR guidelines. Seven themes with 21 subthemes emerged: (1) psychological support (affirmation, active listening), (2) information and health system support (care pathways, health education, prognosis communication), (3) support for physical needs and daily living (symptom management, activity guidance, collaboration), (4) sexual and intimacy support (partner encouragement, alternatives for sexual needs), (5) spiritual support (facilitating worship, spiritual interventions, clergy guidance), (6) social support (family, community, end-of-life preparation), and (7) barriers (patient/family resistance, lack of training, limited clergy, inadequate facilities). Findings highlight the central role of nurses in delivering holistic supportive care, consistent with Dossey's holistic nursing theory. Addressing gaps in palliative training, spiritual resources, and healthcare infrastructure is critical to strengthening supportive care in Indonesia. Results underscore the need for integrating spiritual and palliative care training into nursing curricula, enhancing interprofessional collaboration, and formulating institutional policies to ensure equitable, holistic cancer care.
Downloads
References
I. Soerjomataram and F. Bray, “Planning for tomorrow: global cancer incidence and the role of prevention 2020-2070.,” Nat Rev Clin Oncol, vol. 18, no. 10, pp. 663–672, Oct. 2021, doi: 10.1038/s41571-021-00514-z. DOI: https://doi.org/10.1038/s41571-021-00514-z
M. Arnold et al., “Current and future burden of breast cancer: Global statistics for 2020 and 2040,” The Breast, vol. 66, pp. 15–23, 2022, doi: 10.1016/j.breast.2022.08.010. DOI: https://doi.org/10.1016/j.breast.2022.08.010
R. Khajoei, M. Ilkhani, P. Azadeh, S. Zohari Anboohi, and F. Heshmati Nabavi, “Breast cancer survivors-supportive care needs: Systematic review,” BMJ Support Palliat Care, vol. 13, no. 2, pp. 143–153, 2023, doi: 10.1136/spcare-2022-003931. DOI: https://doi.org/10.1136/spcare-2022-003931
X. C. Lyu, H. J. Jiang, L. H. Lee, C. I. Yang, and X. Y. Sun, “Oncology nurses’ experiences of providing emotional support for cancer patients: a qualitative study,” BMC Nurs, vol. 23, no. 1, Dec. 2024, doi: 10.1186/s12912-024-01718-1. DOI: https://doi.org/10.1186/s12912-024-01718-1
S. Rizalar, E. Hamarat, and S. Goktas, “Supportive care needs after surgery in patients with breast cancer,” Supportive Care in Cancer, vol. 32, no. 9, Sep. 2024, doi: 10.1007/s00520-024-08745-3. DOI: https://doi.org/10.1007/s00520-024-08745-3
B. Yazicioglu Kucuk and P. Zorba Bahceli, “The effects of nurse-led supportive care program on quality of life in women with breast cancer receiving adjuvant chemotherapy: A randomized controlled pilot study,” Semin Oncol Nurs, vol. 40, no. 2, Apr. 2024, doi: 10.1016/j.soncn.2024.151609. DOI: https://doi.org/10.1016/j.soncn.2024.151609
L. Lin, W. L. Koh, Q. Huang, and J. K. Lee, “Breast cancer information behaviours and needs among Singapore women: A qualitative study,” Asian Pacific Journal of Cancer Prevention, vol. 22, no. 6, pp. 1767–1774, Jun. 2021, doi: 10.31557/APJCP.2021.22.6.1767. DOI: https://doi.org/10.31557/APJCP.2021.22.6.1767
E. Hajian-Tilaki, K. Hajian-Tilaki, D. Moslemi, G. Godazandeh, and M. Firouzbakht, “Association of social support, spirituality with psychological factors in Iranian breast cancer survivors: An evidence from a cross-sectional study,” Nurs Open, vol. 9, no. 2, pp. 1173–1180, 2022, doi: 10.1002/nop2.1158. DOI: https://doi.org/10.1002/nop2.1158
M. Bafandeh Zendeh, M. Hemmati Maslakpak, and M. Jasemi, “Nurses’ perceptions of their supportive role for cancer patients: A qualitative study,” Nurs Open, vol. 9, no. 1, pp. 646–654, 2022, doi: 10.1002/nop2.1112. DOI: https://doi.org/10.1002/nop2.1112
F. Vezzani, B. Cabieses, A. Obach, S. Torrealba, and I. Carvajal, “Unmet supportive care needs of young women with breast cancer in Chile during follow-up stage after treatment: A qualitative study,” PLoS One, vol. 20, no. 8 August, Aug. 2025, doi: 10.1371/journal.pone.0330166. DOI: https://doi.org/10.1371/journal.pone.0330166
L. Matshaka, C. Downing, and N. Ntshingila, “Facilitating holistic nursing through the development of mindfulness: A model for student nurses,” Journal of Holistic Nursing, vol. 42, no. 4, pp. 409–419, Dec. 2024, doi: 10.1177/08980101241245824. DOI: https://doi.org/10.1177/08980101241245824
M. J. Doe, “Holistic nursing: An essence of nursing philosophies,” Nurs Sci Q, vol. 35, no. 4, pp. 498–500, Sep. 2022, doi: 10.1177/08943184221115127. DOI: https://doi.org/10.1177/08943184221115127
H. Albaqawi, V. E. Butcon, B. S. Albagawi, M. H. Alshammari, P. Pangket, and R. D. Dayrit, “Investigating the educational competency of student nurses in holistic nursing: Recalibrating holistic education,” International Journal of Advanced and Applied Sciences, vol. 10, no. 3, pp. 82–86, 2023, doi: 10.21833/ijaas.2023.03.011. DOI: https://doi.org/10.21833/ijaas.2023.03.011
P. Garmy, E. K. Clausson, A. C. Janlöv, and E. L. Einberg, “A philosophical review of school nursing framed by the holistic nursing theory of Barbara Dossey,” Journal of Holistic Nursing, vol. 39, no. 3, pp. 216–224, 2021, doi: 10.1177/08980101211006615. DOI: https://doi.org/10.1177/08980101211006615
M. T. Stephens and E. Rochmawati, “The need for palliative care education and training in Liberia and Indonesia: A literature review,” Jurnal Aisyah : Jurnal Ilmu Kesehatan, vol. 7, no. 1, pp. 277–286, Feb. 2022, doi: 10.30604/jika.v7i1.881. DOI: https://doi.org/10.30604/jika.v7i1.881
I. P. Dewi, N. Gartika, S. Sanusi, and D. Suryatiningsih, “Determinants of spiritual well-being that impact breast cancer patients’ quality of life,” Journal of Holistic Nursing, vol. 00, Jun. 2023, doi: 10.1177/08980101231181272. DOI: https://doi.org/10.1177/08980101231181272
I. P. Dewi, A. T. Widiyanti, H. Hidayat, S. N. Holizah, R. Melati, and S. Mikli, “A Delphi study of digital health consensus for improving quality of life among Indonesians with breast cancer,” Journal of Holistic Nursing Science, vol. 12, no. 1, pp. 132–147, Jan. 2025, doi: 10.31603/jhns.v12i1.13219. DOI: https://doi.org/10.31603/jhns.v12i1.13219
L. Judijanto, “The Influence of Religious Beliefs and Religious Practices on Social Cohesion in Modern Society in Indonesia Article Info ABSTRACT,” The Eastasouth Journal of Social Science and Humanities, vol. 1, no. 03, pp. 139–150, 2024, doi: 10.58812/esssh.v1i03. DOI: https://doi.org/10.58812/esssh.v1i03.276
E. Rochmawati, R. Wiechula, and K. Cameron, “Centrality of spirituality/religion in the culture of palliative care service in Indonesia: An ethnographic study,” Nurs Health Sci, vol. 20, no. 2, pp. 231–237, Jun. 2018, doi: 10.1111/nhs.12407. DOI: https://doi.org/10.1111/nhs.12407
D. Barrett and A. Twycross, “Data collection in qualitative research,” Evid Based Nurs, vol. 21, no. 3, pp. 63–64, 2018, doi: 10.1136/eb-2018-102939. DOI: https://doi.org/10.1136/eb-2018-102939
R. Khajoei, P. Azadeh, S. ZohariAnboohi, M. Ilkhani, and F. H. Nabavi, “Breast cancer survivorship needs: a qualitative study,” BMC Cancer, vol. 24, no. 1, Dec. 2024, doi: 10.1186/s12885-024-11834-5. DOI: https://doi.org/10.1186/s12885-024-11834-5
M. Evans Webb, E. Murray, Z. W. Younger, H. Goodfellow, and J. Ross, “The supportive care needs of cancer patients: A systematic review,” Journal of Cancer Education, vol. 36, no. 5, pp. 899–908, 2021, doi: 10.1007/s13187-020-01941-9. DOI: https://doi.org/10.1007/s13187-020-01941-9
X. Chen et al., “Effects of exercise interventions on cancer-related fatigue and quality of life among cancer patients: a meta-analysis,” BMC Nurs, vol. 22, no. 1, pp. 1–16, 2023, doi: 10.1186/s12912-023-01363-0. DOI: https://doi.org/10.1186/s12912-023-01363-0
H. Buche, A. Michel, and N. Blanc, “When virtual reality supports patients’ emotional management in chemotherapy,” Front Virtual Real, vol. 4, 2023, doi: 10.3389/frvir.2023.1294482. DOI: https://doi.org/10.3389/frvir.2023.1294482
Y. Mi et al., “Effects of Swanson theory-based auricular acupressure on chemotherapy-induced peripheral neuropathy, and broader health-related outcomes in patients with breast cancer: A randomized controlled trial,” Asia Pac J Oncol Nurs, vol. 12, Dec. 2025, doi: 10.1016/j.apjon.2025.100729. DOI: https://doi.org/10.1016/j.apjon.2025.100729
R. Fan, L. Wang, X. Bu, W. Wang, and J. Zhu, “Unmet supportive care needs of breast cancer survivors: a systematic scoping review,” BMC Cancer, vol. 23, no. 1, pp. 1–24, 2023, doi: 10.1186/s12885-023-11087-8. DOI: https://doi.org/10.1186/s12885-023-11087-8
M. K. Lee, N. T. T. Levine, L. R. Hayes, C. G. Shields, and Y. Yih, “Navigating the cancer care continuum: A comparative study of Black and White breast cancer patients,” PLoS One, vol. 19, no. 10 October, Oct. 2024, doi: 10.1371/journal.pone.0312547. DOI: https://doi.org/10.1371/journal.pone.0312547
Y. F. Sitanggang and H. R. Lin, “Experiences of Indonesian women with breast cancer underwent treatment decision-making: A qualitative study,” Belitung Nurs J, vol. 10, no. 4, pp. 456–463, Jul. 2024, doi: 10.33546/bnj.3395. DOI: https://doi.org/10.33546/bnj.3395
M. Azam, M. Aslam, J. Basharat, M. A. Mughal, M. S. Nadeem, and F. Anwar, “An empirical study on quality of life and related factors of Pakistani breast cancer survivors,” Sci Rep, vol. 11, no. 1, pp. 1–12, 2021, doi: 10.1038/s41598-021-03696-9. DOI: https://doi.org/10.1038/s41598-021-03696-9
S. Jabeen, R. Zakar, M. Z. Zakar, and F. Fischer, “Experiences of family caregivers in dealing with cases of advanced breast cancer: a qualitative study of the sociocultural context in Punjab, Pakistan,” BMC Public Health, vol. 24, no. 1, Dec. 2024, doi: 10.1186/s12889-024-18404-1. DOI: https://doi.org/10.1186/s12889-024-18404-1
Y. Qan et al., “Quality of life among patients with cancer and their family caregivers in the Sub-Saharan region: A systematic review of quantitative studies,” 2022, doi: 10.1371/journal.pgph.0000098. DOI: https://doi.org/10.1371/journal.pgph.0000098
Mary R Morrow and Barbara M Dossey, “A journey of joy: Dr. Barbara M. Dossey’s evolution in nursing,” Nurs Sci Q, vol. 37, no. 2, pp. 125–133, Mar. 2024, doi: 10.1177/08943184231224441. DOI: https://doi.org/10.1177/08943184231224441
S. Wang et al., “Association between type D personality and supportive care needs in elderly patients with breast cancer: a prospective longitudinal observational study,” BMC Geriatr, vol. 23, no. 1, pp. 1–10, 2023, doi: 10.1186/s12877-023-04407-x. DOI: https://doi.org/10.1186/s12877-023-04407-x
B. C. O’Brien, I. B. Harris, T. J. Beckman, D. A. Reed, and D. A. Cook, “Standards for reporting qualitative research: A synthesis of recommendations,” Academic Medicine, vol. 89, no. 9, pp. 1245–1251, 2014, doi: 10.1097/ACM.0000000000000388. DOI: https://doi.org/10.1097/ACM.0000000000000388
T. V. McCann and D. I. Lubman, “Qualitative process evaluation of a problem-solving guided self-help manual for family carers of young people with first-episode psychosis,” BMC Psychiatry, vol. 14, no. 1, pp. 1–9, 2014, doi: 10.1186/1471-244X-14-168. DOI: https://doi.org/10.1186/1471-244X-14-168
A. Di Meglio et al., “Experiences and preferences about information on treatment-related side effects among patients with early breast cancer,” Breast, vol. 80, Apr. 2025, doi: 10.1016/j.breast.2025.104414. DOI: https://doi.org/10.1016/j.breast.2025.104414
S. L. Herbert et al., “Supportive care and information needs in relation to quality of life among patients with breast cancer and gynaecological cancer during the time of treatment,” Arch Gynecol Obstet, vol. 311, no. 2, pp. 467–479, Feb. 2025, doi: 10.1007/s00404-024-07805-7. DOI: https://doi.org/10.1007/s00404-024-07805-7
G. Johnson, Qualitative data analysis. 2019. doi: 10.4324/9781315701134-11. DOI: https://doi.org/10.4324/9781315701134-11
H. Morgan, “Conducting a Qualitative Document Analysis,” Qualitative Report, vol. 27, no. 1, pp. 64–77, 2022, doi: 10.46743/2160-3715/2022.5044. DOI: https://doi.org/10.46743/2160-3715/2022.5044
T. Ahern, A. Gardner, and M. Courtney, “A survey of the breast care nurse role in the provision of information and supportive care to Australian women diagnosed with breast cancer,” Nurs Open, vol. 2, no. 2, pp. 62–71, Jul. 2015, doi: 10.1002/nop2.18. DOI: https://doi.org/10.1002/nop2.18
M. Seven, Ş. İ. Paşalak, G. Bagcivan, O. Ozkasap, and F. Selçukbiricik, “A Mobile application for symptom management in patients with breast cancer,” Oncol Nurs Forum, vol. 49, no. 5, pp. 409–420, 2022, doi: 10.1188/22.ONF.409-420. DOI: https://doi.org/10.1188/22.ONF.409-420
X. Peng, L. Tang, P. Gao, and W. Liu, “Medical experiences of patients with breast cancer using smart hospital apps: A qualitative study,” Feb. 28, 2025, Elsevier Ltd. doi: 10.1016/j.heliyon.2025.e42573. DOI: https://doi.org/10.1016/j.heliyon.2025.e42573
M. K. Jang et al., “Evaluating the effects of a resistance exercise intervention for sarcopenia in patients receiving neoadjuvant chemotherapy for breast cancer: study protocol for a randomized controlled trial,” BMC Cancer, vol. 25, no. 1, Dec. 2025, doi: 10.1186/s12885-025-14721-9. DOI: https://doi.org/10.1186/s12885-025-15003-0
P. Paal, K. M. Lex, C. Brandstötter, C. Weck, and S. Lorenzl, “Spiritual care as an integrated approach to palliative care for patients with neurodegenerative diseases and their caregivers: A literature review,” 2020, AME Publishing Company. doi: 10.21037/apm.2020.03.37. DOI: https://doi.org/10.21037/apm.2020.03.37
B. M. Dossey, L. Keegan, C. C. Barrere, and M. A. B. Helming, Holistic nursing: A handbook for practice. Jones & Bartlett Learning, 2015. [Online]. Available: https://books.google.co.id/books?id=f4eHCgAAQBAJ
B. Mao, Y. Shen, Y. Chen, P. Zhou, and Y. Pan, “Experiences of healthcare professionals returning to work post breast cancer diagnosis in China: A descriptive qualitative study,” Sci Rep, vol. 15, no. 1, Dec. 2025, doi: 10.1038/s41598-024-82893-8. DOI: https://doi.org/10.1038/s41598-024-82893-8
C. Funasaka et al., “Mitigation of paclitaxel-induced peripheral neuropathy in breast cancer patients using limb-cooling apparatus: a study protocol for a randomized controlled trial,” Front Oncol, vol. 13, 2023, doi: 10.3389/fonc.2023.1216813. DOI: https://doi.org/10.3389/fonc.2023.1216813
H. Tang et al., “Impact of early multidisciplinary team interventions on dietary management behavior in breast cancer patients: a pilot randomized controlled trial,” BMC Cancer, vol. 25, no. 1, Dec. 2025, doi: 10.1186/s12885-025-13991-7. DOI: https://doi.org/10.1186/s12885-025-13991-7
A. Rashidi, S. Thapa, W. S. Kahawaththa Palliya Guruge, and S. Kaur, “Patient experiences: a qualitative systematic review of chemotherapy adherence,” Dec. 01, 2024, BioMed Central Ltd. doi: 10.1186/s12885-024-12353-z. DOI: https://doi.org/10.1186/s12885-024-12353-z
Published
How to Cite
Issue
Section
Copyright (c) 2025 Inggriane Puspita Dewi, Anggriyana Tri Widiyanti, Medina Hutami
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
