Abstract
Breast cancer is a common disease among women, and resilience helps them better cope with the illness and experience personal growth. This study used qualitative research methods to conduct semi-structured in-depth interviews with 15 Chinese breast cancer survivors. To explore the psychosocial factors promoting resilience in them. According to the interview data, after coding and refining the themes, it was found that the social resources of breast cancer survivors include: family support, hospital support, government and social organization support, and cultural support. The psychological factors include cognitive, emotional, and behavioral resources. This is comprehensively reflected in high self-efficacy and control, relatedness, and the ability to manage emotions. Society and individuals influence each other and together constitute protective factors of resilience. Health professionals and social workers should view survivors positively, guide them to tap their abilities and environmental resources, stimulate their resilience potential, and achieve self-reconstruction.
Plain language summary
Some BC survivors seem to cope better than others. This study aimed to identify psychosocial factors that may influence these differences. By encouraging individuals to share their experiences fighting the illness, to inspire and uplift the morale of more BC survivors in resisting risks. Additionally, it contributed to the development of more tailored support plans by healthcare professionals. Hopefully, more people will learn to view illness from a positive perspective, growth, and finding new meaning in adversity.
Impact Statement
Currently, there is no specific measurement tool for resilience tailored to survivors with breast cancer (BC) and similar cancers. Research on resilience should focus on individuals’ psychological states and their surrounding environment, exploring the resilience and adaptability demonstrated by many survivors in face the challenges posed by BC. This study adopts a qualitative research approach, engaging in-depth exploration and interactive discussions with the participants to thoroughly study the psychosocial factors influencing resilience, to identify issues and propose new perspectives on understanding resilience. Provide reference for future development of measurement tools. Research on factors that promote resilience aims to enhance the adaptive capacity of BC survivors and empowering them to successfully navigate the challenges of post-treatment life.
Introduction
BC is the leading cancer incidence in women (GLOBOCAN, 2020). It accounts for a quarter of all cancer cases in women, with approximately 685,000 deaths due to the disease in 2020, which translates to one in every six cancer deaths in women (Sung et al., 2021). BC causes physical pain, mastectomy, limb dysfunction or sequelae such as lymphedema (De Groef et al., 2017), as well as a certain threat of recurrence of the disease, which may result in impairment of the survivor’s self-perception (Kaiser et al., 2019), dysfunction in the family (He et al., 2022), impairment of social interactions (Bidstrup et al., 2015) and other serious problems that will affect the survivor’s self-acceptance, family life, career development, and social adaptation (Ruishu et al., 2014). However, these hazards do not result in serious psychological problems or impairment of social functions for every survivor. Interestingly, some studies have found that some survivors have higher life satisfaction than women with no BC history (Aizpurua-Perez & Perez-Tejada, 2020; Baglama & Atak, 2015; Brandão et al., 2016). When gradually shifting from a problem perspective to a strength’s perspective, The concept of resilience has attracted more and more attention, which has undergone changes from “what it is” (Rutter et al., 2008) to “how it is produced” (Gaines et al., 1997) to “how to intervene” (Weissberg & Greenberg, 1998), and “how to integrate multi-layer systems” (Masten, 2007). In such changes, the concept of resilience is gradually understood as “adaptation” in the interaction between individuals and the environment (Schoon, 2006). Only when the two work together can the negative impact of crisis events on individuals be alleviated. (Rutter et al., 2008).
Individual refers to resilience traits such as self-efficacy (Bandura, 1977), sense of mastery (Ben-Zur, 2003), tenacity (Wu et al., 2018), and coping ability (Smith et al., 2011; Shukri & Badayai, 2020). The environment is reflected in the level of social support. Family, as a fundamental part of society, is the most important source of material and spiritual support for family members. The perceived social support of BC survivors is related to the level of hope, post-traumatic growth, and well-being index, and the more social support perceived by survivors helps them overcome the negative effects of the disease, resulting in more positive experiences (Dong et al., 2024). Exploring the factors that promote resilience from both personal and environmental perspectives is very important in explaining resilience. Psychosocial factors are anything that determines how people cope with the demands and challenges of daily life, maintain a state of mental health, and behave when interacting with other people, their culture, and their environment (Thomas et al., 2017). Therefore, to improve the resilience of survivors, it is first necessary to explore what are the psychosocial factors that promote resilience.
Most previous studies were conducted using quantitative research methods based on scales. However, there is currently no targeted measurement tool for the psychological resilience of cancer survivors such as BC. Scholars often use the CD-RISC scale designed in a Western context instead (Song et al., 2022). This study hopes to explore social psychological factors in the Chinese environment, so it uses qualitative research and is committed to obtaining a more comprehensive explanation of the quality of things (Silverman & Marvasti, 2008). Through in-depth interviews with BC survivors, to understand the physiological, psychological, and social factors that affect them, and provide a reference for the development of resilience measurement tools for BC survivors. Focus on the psychosocial factors that promote the resilience of BC survivors to determine relevant indicators and areas, and guide intervention measures to enhance resilience.
This study is guided by Kumpfer’s (1999) resilience model, which is based on the fusion of the interaction model from the social-ecological perspective and the person-process-environment model from the systems perspective. Kumpfer divides the resilience process into two stages: the pre-resilience process, which is the interaction process between the individual and the environment; and the post-resilience process, which is the operation process of resilience. This study mainly refers to the pre-resilience process. Resilience emerges with the emergence of stressors or challenges, people in the environment, social support, and the individual’s inner psychological resources have an important influence on the development of individual resilience. Therefore, this study attempts to further understand the psychosocial factors that promote the resilience of BC survivors, and discuss how these protective factors affect them, intending to improve the psychological recovery of BC survivors. It also provides new perspective and theoretical basis for care or intervention.
Ethics Approval
This study was approved by the university research committee.
Methods
Design
This study was qualitative research that used case study design, utilizing semi-structured in-depth interviews to obtain rich, vivid, specific, and detailed information. This study believes that the topic of personal resilience is more suitable for qualitative research, which seeks answers to the “how” or “why” questions about ambiguous phenomena (Thorogood & Green, 2018). Through interactions with the research participants, researchers have in-depth and detailed experience of the research issues and obtain a relatively comprehensive explanation of the nature of things. (Silverman & Marvasti, 2008). At the same time, the in-depth interview method is more conducive to paying attention to the interaction between the individual and the environment. For example, it can compare actual social support with the support perceived by survivors to avoid separating the environment from the individual. Finally, in-depth case interviews are also more helpful for researchers and more suitable for some sensitive topics that BC may involve.
Sampling Strategy
A total of 15 BC survivors were recruited for this study using purposive sampling (Strauss & Corbin, 1998), select research objects based on the needs of the research purpose and the subjective judgment of the researcher. National Coalition for Cancer Survivorship (NCCS) proposed a definition of cancer “survivor” in 1986, which was later defined as “An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life” (Twombly, 2004). Treatment for BC includes multiple stages such as surgery, radiotherapy, chemotherapy, and endocrine therapy, and may last from weeks to months or even longer (Cancer.net, 2022). In this study, BC survivors refer to those who have successfully passed the treatment stage, successfully entered the recovery stage, and returned to daily life. According to the purpose of the research, select those cases that can provide very dense and rich information for the research problem. These cases are not necessarily very extreme or unusual. Therefore, the study selected BC survivors who regularly participate in activities at the Beijing Pink Ribbon Institution (BPRI) and are recognized as positive and optimistic. Participants are usually not completely selected in advance, but are gradually selected after the actual research begins to avoid the researcher’s preconceived subjective assumptions. The initially selected participant leads the researcher to other sources of information that are similar or dissimilar. This study plans to select survivors who have been diagnosed with BC for more than 1 year and are recovering well for interviews, and they should be female, over 25 years old, from the BPRI. .
Data Collection
After approval by the head of BPRI, the participants were contacted and further signing the informed consent form. Individual interviews mainly through face-to-face conversations or telephone calls. Based on the principle of “saturation” of the information provided by the research subjects, 15 BC survivors were finally interviewed. The entire interview process was recorded with the consent of the participants and compiled verbatim into a transcript by the author. The average interview time for each participant is 2 hr, and the transcripts of the interview materials range from 4,000 to 7,000 words, and then converted the audio-recorded data of the interviews into textual data (transcription) and organized them.
The interview protocol consisted: (i) BC diagnosis and treatment experience, (ii) experiences and feelings during treatment and recovery, (iii) what kind of problems have been encountered during this period, (iv) how to deal with the problems and what kind of help have been received, and (v) what kind of good changes have taken place before and after the illness? Initially, three individuals were selected to conduct a pilot test of the interview questions. Based on the results of these preliminary interviews, the questions were adjusted for clarity and effectiveness. During the main interviews, careful attention was given to the order and wording of the questions. Interviews were conducted with additional participants, maintaining an open and flexible approach. The interviewer avoided rigid adherence to the interview format, continuously learning from each interview and making necessary adjustments. Try to avoid the appearance of interviewer bias.
Data Analysis
The data were analyzed using an inductive approach (Braun & Clarke, 2006), and the process of thematic analysis was as follows: (1) Data Familiarization: transcribing the audio recordings of the interviews verbatim and reading them over and over again to jot down initial ideas. (2) Generating Initial Codes: coding recurring, meaningful statements into small phrases or keywords representing specific ideas. (3) Searching for Themes in the Data: categorizing and grouping coded ideas into high-level themes. (4) Reviewing Themes: further checking that themes are relevant to the previous raw data and codes, and generating a thematic map for the analysis. (5) Creating a Report: link the themes to the research phenomenon to provide a detailed and complete description of the analysis, and relate the analysis to its search questions and the literature to generate a scholarly report on the analysis.
Trustworthiness
This study used the quality assessment model proposed by Guba and Lincoln to test the validity of qualitative research (Ritchie et al., 2013). Pre-interviews were conducted prior to the formal interviews to determine the criteria of the participants, validate the interview outline, and improve the interviewing skills. The researcher follows the scientific research method and remains value-neutral to reduce the threat to the credibility of the qualitative research. In the data collection stage, a good relationship is established with the participants, the purpose and significance of the study are introduced in detail, and the participants are made to understand the importance of the study and actively cooperate with the interviews. When it comes to some sensitive issues, use careful wording or indirect questioning interview techniques to give the participants a sufficient sense of security and reduce the possibility of social desirability bias among participants. During the interview process, participants were guided to describe specific events in their memories, rather than asking them about their views or motivations for those events, to avoid participants’ recall bias. In the data analysis stage, verbatim transcription was adopted to maximize the authenticity of the transcribed text. Thematic analyses and refinements were carried out with respect for the values of the participants, following the original source material with an open mind and avoiding the addition of any personal inferences, subjective assumptions, and value orientations.
Findings
Participants
A total of 15 BC survivors were recruited for this study. Details of the participants’ information are given in Table 1.
Demographic Information of BC Survivors.
Themes
Social factors include: family, hospital, government, social organization, and cultural support. And psychological factors include three themes: cognitive, emotional, and behavioral resources. Protective psychosocial resources are the core of resilience, capable of resisting the risk factors of adversity.
Social Factors
Family Support
Family support includes support from partners, parents, and children, as well as support from extended families. Some survivors (n = 7) said the love and firm support of the husband will bring strength and confidence to her. Survivor 3 said: “Mom is someone I can rely on and relax with.” The children are always the most important thing for the survivors (n = 5). Survivor 5 said: “In order to prevent the children from losing their mother prematurely, I began to face the disease bravely.” The adult children can now take charge of their own business and their mothers, initiatively, which is very gratifying and touching for their mothers (n = 2). Some survivors who live in large families have many relatives. Survivor 13 said: “I feel so warm and cherished when everyone expresses care and love.”
Hospital Support
In addition to treating illnesses and saving lives, it is also important for doctors to pay attention to the psychological problems of survivors. The doctor has met countless people and knows the survivor’s anxiety problems. Survivor 10 said: “The doctor told me that I am already a normal person and should not keep the concept of a patient in my heart, otherwise I will always be a patient.” A word of encouragement from the doctor has a great comforting effect on the survivors (n = 10). BC survivors support each other in the hospital (n = 12). Because BC survivors have experienced the pain of the disease, they are willing to help others.
People who share the same disease always have endless things to talk about, such as treatment, life, work, insurance, and children, because others cannot understand. (Source: Survivor 5)
Government and Social Organization Support
China’s medical insurance system helps BC survivors pay part of their medical expenses. Medical insurance usually covers the cost of surgery, radiotherapy, chemotherapy, etc. It also covers the cost of certain treatments, such as targeted therapy drugs or hormone therapy.
Thanks to the medical insurance for allowing ordinary people like me to use medicines at low prices. I sincerely thank the country for its good policies. (Source: Survivor 15)
However, China’s current medical insurance coverage and reimbursement ratio are limited. Therefore, some survivors may consider purchasing additional private medical insurance to supplement their medical insurance coverage (n = 3).
The social organization provides a platform for BC survivors to communicate and make friends. Many survivors (n = 8) mentioned BPRI and other cancer advocacy groups as providing important platforms for emotional support, experience sharing, and information exchange for BC survivors. Survivor 1 said: “Holding together for warmth is very important for us.” And Survivor 5 said: “We asked other survivors questions about the disease, and many of them were very knowledgeable and knew more than the doctors.”
Cultural Support
The cultural support includes Chinese traditional culture and religion. China has a profound cultural heritage. When survivors have doubts, they can often find answers in the culture (n = 4). Survivor 6 said: “I have studied ancient Chinese cultural classics such as the Book of ‘I Ching’ and the ‘Huangdi Neijing’ etc., and experience various kinds of physical and mental healing, slowly exploring the inner world and the larger world.” Religion teaches survivors many principles of life and work, such as the view of suffering. Survivor 2 said: “Everyone has to go through tribulations, and only by letting go of resentment can they be reborn. Everything that happens is a cycle of cause and effect, and people must accept it calmly.”
Psychological Resources
Cognition
Cognition is defined as the brain’s ability to acquire, process, store, and retrieve information (Khera & Rangasamy, 2021), and consists of key elements such as attention, perception, memory, motor skills, executive functions, and speech and language skills (Gellman & Rick Turner, 2013). Optimism is known as a cognitive bias (Dricu et al., 2020), which is a stable and vital positive resource and tendency in personality, which can usually be used as an important variable in predicting positive experiences within an individual (Chiesi et al., 2013). Belief is a person’s firm confidence in a certain thing or situation, usually based on personal values, experience, and a high level of self-control (Fu et al., 2021). This belief inspires their motivation and efforts. It is persistence in goals and awareness of the ability to achieve them.
Even if my current situation is not very optimistic, even if it is questioned by professionals, even if it costs more. I will also move step by step towards the goal I believe in. (Source: Survivor 8)
BC is the closest test to death for them, which gives them the opportunity to think about life. Survivors who have witnessed the death of life will have a different understanding of the meaning of life. Survivor 1 believe that death is a part of life and there is no need to be afraid or worried about it. Survivor 15 is cherish the present more and do not worry about the future or dwell on past regrets. Re-examining and thinking about one’s own life can help people better understand the meaning of life.
Survivor 1 was afraid that her family would be worried, so she did not tell her parents about her illness, and went to the hospital alone. When dealing with difficulties, they emphasize relying on their own strength to overcome difficulties (n = 3). This fearlessness and perseverance in the face of challenges is summed up as tenacity. Tenacity is usually characterized by a person’s ability to remain steadfast, maintain a positive attitude, be flexible, and take positive actions to overcome challenges when faced with difficulties, setbacks, or adversity (Kobasa, 1979).
In addition to the above cognitive abilities, two other important protective factors are individual insight and reflection. Insight is a person’s ability to deeply understand and grasp a problem, situation, or information. Survivor 2 realized that: “There is no absolute authority in medicine, and in reality, there will be over-medication. We should deal with medical treatment more rationally.” Having good insights can help people better understand complex problems, make informed decisions, solve difficult problems, and gain a deeper understanding of themselves and others. Survivor 1 realized that her own misconceptions were causing her fear of death, so she readjusted herself to reduce negative emotions.
Reflection facilitates personal growth, problem-solving, decision-making, and continuous improvement. Survivors who are reflective are better able to examine past behaviors and decisions to identify factors that may have contributed to their illness (n = 13), so they can abandon unhealthy lifestyles. Reflection can also help individuals better understand and grow themselves, rethink values and the meaning of life, and work towards a better direction in the subsequent life course.
Reflecting on my past life, I suddenly realized I was too obsessed with gains and losses, and neglected myself. So I secretly made up my mind to love myself for the rest of my life! (Source: Survivor 14)
Emotion
Emotional intelligence refers to the ability to interpret, control, and use emotions, which plays a core guiding role in individual behavioral changes. Zautra et al. (2005) believe that individuals with high emotional intelligence also have a high tolerance for stress. Individuals with high emotional intelligence can accurately perceive and evaluate their own emotions, know and how to express their feelings, and can effectively regulate their emotional state. Survivors 5 mentioned: “When I was weak, I would allow myself to cry, and then I would become calmer and firmer inside.”
Humor is an ability with specific thinking and emotional characteristics. People with a sense of humor tend to look at problems in new and interesting ways and are more optimistic. They could cope with the challenges of life in a positive and relaxed way. When the doctor asked if they could undergo total surgery, Survivors 12 joked that: “Anyway, I wasn’t plump, so after the surgery I became a ‘Shao nai nai’ (means young lady) in the future.” She used the homophonic metaphor of “lack of breasts” to relieve the pressure and bring laughter to others and herself.
Behavior
Hobbies can satisfy psychological and emotional needs. They provide a positive outlet that enables people to develop personal interests and foster creativity and personal satisfaction, thereby promoting mental health and well-being. Survivor 7 said: “I like watching the TV series ‘Dear, Beloved’. The plot relieves my depression, and the spirit of the protagonist also inspires me.” After getting sick, some survivors left their jobs and had a lot of free time every day to pursue some personal interests (n = 6). Survivor 2 participated in some club activities and learned some specialties. A rich life experience can delight people’s hearts and increase social opportunities.
For survivors, whether they can reintegrate into society after discharge and adapt to new roles is related to the individual’s willingness and ability to socialize. Generally, extroverted survivors have stronger social skills (n = 3), and individuals who like to be alone are more likely to close themselves off (n = 1). Survivor 8 said: “After I got sick, I seldom went out and felt that life was boring, so I started to take the initiative to meet more people and participate in BPRI’s activities.” Having good social skills can improve happiness in life.
Discussion
In their trajectories of cancer treatment and recovery, both environmental and individual protective factors play an important role in promoting the development of resilience, and the two influence each other. Guided by the Kumpfer resilience model, how protective factors function and how individuals interact with the environment deserves further discussion.
At the environmental level, human existence cannot be separated from society. Obtaining social support is indispensable to help cancer survivors (Caprara et al., 2016; Mahdian & Ghaffari, 2016; Saboonchi et al., 2014). Social support can be divided into formal support and informal support (Thomas et al., 2020). Governments, hospitals and social organizations bring more formal support in terms of policies and services; family members and other BC survivors bring more informal support in the form of care and concern. Although formal support from various organizations to promote individual welfare has brought great help to BC survivors, care for survivors still relies heavily on informal social support networks based on blood and kinship ties (Howard-Jones et al., 2022; MA et al., 2014). At the same time, governments and hospitals also need to pay more attention to the psychological problems of BC survivors. For example, Xiao (2016) believes that doctors are accustomed to expressing patients’ symptoms in a standardized and “dehumanized” way, which is far removed from the patient’s life world. Although social organizations have provided material and spiritual support, there is still a lot of room for improvement in their professional capabilities and service scope. This is also related to the fact that China mainly adopts the method of government procurement of services. Social organizations have unequal distribution of resources and fees in different regions and uneven service quality (Cortis et al., 2018). BC survivors, as a relatively special social group, are affected by society in many aspects. Support for them cannot only rely on family strength, but it is also very important to build a social support network. BC survivors with strong social support have a better quality of life, are more optimistic, and enjoy better mental and emotional health (Black et al., 2020; Niitsu et al., 2017). However, the extent to which individuals benefit from the same objective support However, the degree to which an individual benefits from the same objective support also depends on the individual’s subjective perception, and it is the perceived support that can truly influence the individual’s adaptation to the situation (Di Giacomo et al., 2016; Zhou & Lin, 2016).
In addition, in the macro environment, culture implicitly has a profound effect on all of society. Some survivors found many ways to cultivate themselves in the culture. Culture influences how people interpret adversity and how they are expected to cope with it (Raghavan & Sandanapitchai, 2019). Chinese people regard adversity as a test or fate (Chen et al., 2008). This further creates the tenacious and optimistic character of the Chinese people. However, Culture also tends to make Chinese people introverted and not show their emotions, which may cause some miscommunication in family relationships. People may be more cautious in choosing friends during social interactions to prevent causing inconvenience to others and further close themselves (Kinnison, 2017). The development of new media has brought new online social opportunities to the BC community. More BC survivors are sharing experiences and comforting each other online. The anti-cancer effect of teamwork far exceeds one person’s energy (Ramos et al., 2018). In the context of peer groups, individuals feel more social support.
At the individual level, BC survivors are stimulated to develop cognitive, emotional, and behavioral protective factors under adversity. This is the inner strength formed by their resilience, which enables them to effectively respond to crisis events. The cognitive level includes optimism, meaning of life, resilience, insight and reflection, which comprehensively reflects individual self-efficacy (Bandura, 1977) and sense of control (Ben-Zur, 2003). Self-efficacy is an individual’s subjective judgment, evaluation, and belief on whether one can successfully complete a task (Bandura, 1977). Mastery refers to the degree to which an individual perceives and controls the impact of one’s behavior on the surrounding environment (Ben-Zur, 2003). Individuals who are optimistic and resilient are confident about disease management and future life, and therefore have a high self-efficacy and mastery (Gallagher et al., 2019; Ramírez-Maestre et al., 2019; Wang et al., 2016). Mastery can give survivors a sense of security. Face BC more rationally, believe in their ability to achieve goals, and have more confidence in the prognosis of the illness. After reasonable planning and learning, it will help further reduce anxiety and collapse, and the higher self-efficacy will be (Baker et al., 2016; Quinton et al., 2019).
Emotional reactivity is also a vital psychological factor. Individuals will have negative emotions when facing BC, and individuals with strong resilience are usually able to regulate their emotions more effectively, avoid excessive negative emotions, stay calm, and find solutions to problems (Brandão et al., 2017; Guil et al., 2020). Sarrionandia et al. (2018) believe that individuals with high emotional support also have a high tolerance for stress, and emotional support is a resource for resilience in coping with pain. How BC survivors regulate their emotions affects their quality of life and enhances resilience to illness (Amirifard et al., 2017; Baudry et al., 2018; Brandão et al., 2016).
Emotions and behaviors are also interrelated and together they form an individual’s response to the external environment and internal experiences. Through positive behaviors, such as exercising, engaging in rewarding social activities, or pursuing personal interests, individuals can improve their emotional state. The most noteworthy behavioral finding is sociability, which can serve as a buffer against stress due to the sense of connectedness that social interaction brings to BC survivors (Prince-Embury, 2014). The importance of relationships to human resilience has been noted in every major review of resilience protective factors (Kansky, 2017; Marroquín et al., 2016). At the same time, a sense of relatedness is also inseparable from positive self-awareness and self-complexity. These positive psychological resources help survivors get rid of the shame of the disease when interacting with others, be able to view their own changes more rationally and reduce self-isolation. When individuals are in difficulty, they believe that others can seek support from others, which means they have a higher understanding of social support. Understanding social support is more likely to show gainful functioning of an individual’s mental health (Noor, 2015; Salleh & Mokhtar, 2022).
To sum up, the social psychological factors that promote the improvement of individual resilience include multiple aspects of social psychology. As Ungar (2013) said, psychological resilience is both a personality structure and an environmental characteristic. To help BC survivors improve their individual resilience, intervention can be done from two main directions: increasing environmental support and stimulating individual traits. When the overall number of protective factors is greater than that of risk factors, the negative impact of risk factors will be buffered, and the individual’s adaptation effect will be better (Kumpfer, 1999).
Conclusion
This study used qualitative research methods to describe the psychosocial factors that promote resilience among Chinese BC survivors. Based on Kumpfer’s resilience model, we have a clearer understanding of the process by which these protective factors improve resilience. People in the environment, and individuals are affected by various social factors. Chinese culture has created the unique spiritual core of the Chinese people. Support for BC survivors mainly comes from families and cancer groups, with the government and society playing a complementary role in supporting BC survivors. The psychological resources displayed by many people also provide important support in treating illness and adjusting to life. These psychological resources come from three aspects: cognition, emotion, and behavior, including self-efficacy and a sense of control, a sense of connection that promotes interpersonal relationships, emotion management capabilities, and an understanding of social support.
Health professionals and social workers should pay attention to maladjusted survivors, help them discover their problems and needs, tap into their social and psychological resources, help them correct misunderstandings and actions, recognize their abilities to provide hope and empower them to improve their effectiveness. Ability. In addition, online and offline platforms for BC groups can also be built, using group work methods to improve the level of mutual aid within the BC group, and at the same time pay attention to the families of BC survivors and provide support for their families. This is of great significance in promoting social integration, reducing the loneliness and anxiety of survivors, and thereby improving their resilience. Finally, for BC survivors, acquiring a resilience perspective will help them believe in their abilities in the process of fighting the disease and anticipate common risks in cancer treatment. It helps them get help from other people’s experiences and view trauma with a more positive attitude.
Research Limitations
This study has several limitations. First, the relatively small sample was only from BPRDS and may not be indicative of the extent and diversity of resilience factors among other BC survivors in China. In addition, Beijing’s medical and social resources are much higher than those in other regions, and the description of social support may not be representative of the characteristics of other regions in China.
Then, during the interview, the subjects are asked to reflect on the experience of treatment and their current perceptions of changes, and the descriptions in the recollections may be partially distorted. However, it can be argued that research that understands the perspectives of the parties from their perspective, pays attention to their psychological state and meaning construction, and guides them in seeking answers to such ambiguous questions about the influencing factors of resilience is a characteristic of qualitative research. An individual’s subjective perception of change is more important than objective and observable changes, consistent with the philosophical view that there is no “objective” but only “subjective” reality (Winkler, 2005).
Footnotes
Acknowledgements
The authors would like to acknowledge all those who provided support and help during the completion of this thesis and the information provided by references. Special thanks to BC survivors, supervisors, family, and friends for their support and cooperation.
Author Contributions
Ruishu Dong conceived and designed the study, conducted the literature review, wrote the manuscript, and led the data collection and analysis process. Nur Saadah Mohamad Aun assisted in the study design, participated in data analysis, and provided critical revisions and feedback on the manuscript. Aizan Sofia Amin and Nazirah Hassan jointly contributed to the interpretation of the research findings and assisted in drafting and revising the manuscript. All authors read and approved the final manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval
This study was approved by the UKM Research Ethics Committee (Ethics Code No. JEP-2023-728).
Consent Details
All participants involved in this research were fully informed about the nature, purpose, and potential risks of the study. Informed consent was obtained prior to their participation. The participants were assured that their involvement was voluntary and that they could withdraw from the study at any time without any negative consequences.
Data Availability Statement
The data supporting the findings of this study are not publicly available due to privacy concerns. However, data may be available from the corresponding author, Ruishu Dong, upon reasonable request and subject to ethical approval.