Volume 29, Issue 3 (Summer 2021)                   Avicenna J Nurs Midwifery Care 2021, 29(3): 220-232 | Back to browse issues page

Ethics code: 706960/د/5 و کد اخلاقIR.TBZMED.REC.1396.1253

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Zamanzadeh V, Ghahramanian A, Valizadeh L, Mazaheri E. Strategies Used to by Mothers with Breast Cancer to Apply the Mothering Role: A Qualitative Study. Avicenna J Nurs Midwifery Care 2021; 29 (3) :220-232
URL: http://nmj.umsha.ac.ir/article-1-2239-en.html
1- Professor in Nursing, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
2- Associate Professor, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3- Professor in Nursing, Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
4- Assistant Professor, Faculty of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran , mazaherieffat@yahoo.com
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✅ Identifying the strategies used to play the mothering role can help health care professionals to support, provide advice, and train the mothers with breast cancer and their families. It also helps mothers to play their mothering role during the disease.

Extended Abstract:   (656 Views)

Women with breast cancer often experience alterations in their mothering roles because of the disease and the reduced ability for child care. However, many women with breast cancer try to play their mothering roles as before the illness. This study aimed to discover the strategies used by Iranian women with breast cancer to manage their mothering roles in the process of the disease and survival.

Materials and Methods

A qualitative content analysis study was conducted on 23 mothers with breast cancer. Semi-structured interviews were used to collect data and a conventional content analysis method was used to analyze the data simultaneously with data collection.



Totally 1200 non-duplicate codes were extracted from the data and were categorized into four categories. Self-preparation was the first category and included three subcategories, namely, self-awareness for regaining the role, psychological mobilization to continue the role, and seeking informational support. Role reorganizing was the second category and had two subcategories, namely assigning to alternate people and modifications of maternal duties. Self- and family reconstruction was the third category and included three subcategories of energy conservation, communication development, and child protection. Playing a participatory-supervisory role was the fourth category and had two subcategories of participation and supervision.



The first class that the participants disputed was "self-preparation" with the subcategories "conscious role-playing", "psychological mobilization to continue the role", and "gaining intelligence support". Participating mothers continued to play their motherly role by recognizing and prioritizing their children's changing needs applying their preparation strategy. Findings from a study by Wilson et al. on mothers with chronic illness showed that survival-motivated mothers sought to reshape their identity as mothers [26] encouraged by those around them and with mental focus on performing tasks in mobilizing their psychic powers. In this regard, Noorisanchooli et al. reported that mothers with cancer undergoing chemotherapy receive financial and moral support from family and others during diagnosis and treatment, and these supports help them regain their motherly role  [27].
The second category that the participants expressed was "reorganizing the roles" with the subcategories "advocating for alternatives" and "modifying the tasks of the maps." Participants experienced multiple roles in the new situation based on their experience of the role of the disease and used strategies to advocate for alternatives and modify role tasks to reshape the situation. In line with this finding, Vaziri et al. point out that mothers with mastectomy breast cancer cannot perform their management roles at home by focusing on treating the disease; therefore, family members should take on more responsibilities [16]. Other studies, in line with the findings of this study, support the need for mothers with cancer to involve family members in care and to perform the duties of mothers at home [6, 29]. The results showed that the participants adjusted the tasks of the roles to focus on the priority needs of their children by prioritizing the mother role over other roles. Given the socio-cultural context of Iran, mothers are expected to perform their duties as mothers even during illness [30]; this finding is not unexpected.
The third category that emerged in the conversation with the participants was "self-reconstruction and family" with the sub-categories "energy storage strategies", "communication development" and "child protection". Using these strategies, mothers tried to continue their motherly role and repair the damage caused by the disease in themselves and their children. Simplification and organization of tasks and mental guidance through spiritual resources, music and concentration were among the features of energy storage strategy in this study. A study by Sadeghi et al. also showed that listening to music, meditation, and recreational activities can effectively reduce fatigue and maintain energy in women with breast cancer, [33] which was consistent with our study.
Developing relationships was another dimension of rebuilding oneself and one's family. Mothers used this strategy to help their children develop socially. Mothers were trying to increase their children's interactions with others. In line with the results of this study, a study on parents with cancer showed that mothers do their best to create a normal situation at home so that children can continue their normal activities and communication despite the mother's illness [34]. Protecting children was another strategy used by mothers, who tried to keep children unaware about the disease and treatment, and by hiding the severity of the symptoms and pretending to improve in an effort to reduce the psychological burden of the disease.
The "supervisory participatory model" was the fourth category that emerged in talking to participants with the "equity" and "supervision" subcategories. Comparing the findings of the present study with other studies, the interesting finding of this study was the use of a planned and supervised mother role alternative strategy that helped mothers in terms of their physical and mental ability in the course of the disease, the amount of assistance received from them and the share. Thus, through participatory decisions with alternatives and modeling their care programs, mothers gradually tried to gain the most of the mother role in terms of disease and recovery stages with the least supervision of alternative caregivers. Numerous studies have shown that mothers with breast cancer make great efforts to be good mothers by prioritizing their children's needs to normalize their children's routines and household chores. 



Identifying the strategies used to play the mothering role can help health care professionals to support, provide advice, and train the mothers with breast cancer and their families. It also helps mothers to play their mothering role during the disease. 



This article is taken from the doctoral dissertation of Nursing, which has been approved by the Vice-Chancellor for Research and Technology and the Ethics Committee of Tabriz University of Medical Sciences, No. 706960 / d / 5 and the code of ethics IR.TBZMED.REC.1396.1253. The Vice-Chancellor for Research and Technology of Tabriz University of Medical Sciences is hereby thanked for the financial support of this study. All participants in the study are also thanked and appreciated.

Conflicts of Interest

The authors declared no conflict of interest.


Type of Study: Original Research | Subject: Nursing
Received: 2020/10/3 | Accepted: 2021/04/15 | Published: 2021/09/21

1. Haghighat S, Akbari M, Ghaffari S, Yavari P. Standardized breast cancer mortality rate compared to the general female population of Iran. Asian Pac J Cancer Prev. 2012; 13(11):5525-8. [DOI:10.7314/APJCP.2012.13.11.5525] [PMID]
2. Shahidsales S, Hosseini S, Ahmadi-Simab S, Ghavam-Nasiri M. The importance of prognostic factors (ER, PR, P53) in breast cancer and their relationship with stage of disease. Med J Mashhad Univ Med Sci. 2014; 57(2):457-63.
3. Alligood M, Tomey A. Nursing theorists and their work. 5 ed. St. Louis: Elsevier; 2014.
4. Brown SG, Hudson DB, Campbell-Grossman C, Kupzyk KA, Yates BC, Hanna KM. Social support, parenting competence, and parenting satisfaction among adolescent, African American, mothers. West J Nurs Res. 2018; 40(4):502-19. [DOI:10.1177/0193945916682724] [PMID] [PMCID]
5. Vallido T, Wilkes L, Carter B, Jackson D. Mothering disrupted by illness: a narrative synthesis of qualitative research. J Adv Nurs. 2010; 66(7):1435-45. [DOI:10.1111/j.1365-2648.2010.05350.x] [PMID]
6. Ambrósio DCM, Santos MAd. Social support to women after mastectomy: a review study. Cien Saude Colet. 2015; 20(3):851-64. [DOI:10.1590/1413-81232015203.13482014] [PMID]
7. Bultmann JC, Beierlein V, Romer G, Möller B, Koch U, Bergelt C. Parental cancer: Health‐related quality of life and current psychosocial support needs of cancer survivors and their children. Int J Cancer. 2014; 135(11):2668-77. [DOI:10.1002/ijc.28905] [PMID]
8. Yfantis A, Intas G, Tolia M, Nikolaou M, Tsoukalas N, Lymperi M, et al. Health-related quality of life of young women with breast cancer. Review of the literature. J BUON. 2018; 23(1):1-6.
9. Tavares R, Brandão T, Matos PM. Mothers with breast cancer: A mixed‐method systematic review on the impact on the parent‐child relationship. Psycho‐Oncology. 2018; 27(2):367-75. [DOI:10.1002/pon.4451] [PMID]
10. Strickland JT. Helene Hudson Lecture Young mothers’ engagement with the cancer care system. Can Oncol Nurs J/Revue canadienne de soins infirmiers en oncologie. 2015;25(3):270-4.
11. Mousvi Diva R, Moghadam N, Amani O. Evaluating family functioning and spiritual health in women with breast cancer, cancer-treated and healthy women. Iran J Psych Nurs. 2017; 5(5):49-56. [DOI:10.21859/ijpn-05057]
12. Goodwin S, Huppatz K. Mothers making class distinctions: the aesthetics of maternity. The Good Mother: Contemporary Motherhoods in Australia. Sydney: Sydney University Press; 2010. p. 69. [DOI:10.2307/j.ctv1sr6kgj.8]
13. Bultmann JC BV, Romer G, Möller B, Koch U, Bergelt C. Parental cancer: Health‐related quality of life and current psychosocial support needs of cancer survivors and their children. Int J Cancer 2014; 135(11):77-2668. [DOI:10.1002/ijc.28905] [PMID]
14. Whitehead L, Jacob E, Towell A, Abu‐Qamar Me, Cole‐Heath A. The role of the family in supporting the self‐management of chronic conditions: A qualitative systematic review. J Clinic Nurs. 2018; 27(1-2):22-30. [DOI:10.1111/jocn.13775] [PMID]
15. Drageset S, Lindstrøm TC, Giske T, Underlid K. Women's experiences of social support during the first year following primary breast cancer surgery. Scand J Caring Sci. 2016; 30(2):340-8. [DOI:10.1111/scs.12250] [PMID]
16. Vaziri S, Lotfi Kashani F, Akbari ME, Ghorbani Ashin Y. Comparing the motherhood and spouse role in women with breast cancer and healthy women. Iranian J Breast Dis. 2014; 7(2):76-83.
17. Ruddick S. Maternal thinking. Fem Stud. 1980; 6(2):342-67. [DOI:10.2307/3177749]
18. De Castro EK, Dornel ALK, De Sousa MA. The experience of motherhood during treatment. Int J Behav Med. 2018; 23(39559):1-16. [DOI:10.4025/psicolestud.v23i0.39559]
19. Hashemi‐Ghasemabadi M, Taleghani F, Kohan S, Yousefy A. Living under a cloud of threat: the experience of Iranian female caregivers with a first‐degree relative with breast cancer. Psycho‐Oncology. 2017; 26(5):625-31. [DOI:10.1002/pon.4198] [PMID]
20. Arber A. How do nurses "Think Family" and support parents diagnosed with cancer who have dependent children? Asia-Pac J Oncol Nurs. 2016; 3(3):214. [DOI:10.4103/2347-5625.189809] [PMID] [PMCID]
21. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. 7 ed. Philadelphia: Lippincott Williams & Wilkins; 2010.
22. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurs Educ Today. 2004; 24(2):105-12. [DOI:10.1016/j.nedt.2003.10.001] [PMID]
23. Software V. MAXQDA analytics pro [Computer program]. Author Berlin; 2016.
24. Lincoln YS, Guba EG. Naturalistic Inquiry. illustrated, reprint ed. New York: Sage publications; 1985.
25. Ainsworth MDS, Blehar MC, Waters E, Wall SN. Patterns of Attachment: A psychological study of the strange situation. Classic ed. London: Taylor & Francis; 2015. [DOI:10.4324/9781315802428]
26. Wilson S. ‘When you have children, you’re obliged to live’1: motherhood, chronic illness and biographical disruption. Sociol Health Illn. 2007;29(4):610-26. [DOI:10.1111/j.1467-9566.2007.01008.x] [PMID]
27. Noorisanchooli H, Rahnam M, Haghighi MJ, Hashemi SA, Younesbarani Z. The familial experiences of women with breast cancer referring to chemotherapy clinic: A qualitative study. Clin Cancer Invest J. 2018; 7(6):210-6. [DOI:10.4103/ccij.ccij_92_18]
28. Rashi C, Wittman T, Tsimicalis A, Loiselle CG. Balancing illness and parental demands: Coping with cancer while raising minor children. Oncol Nurs Fourm. 2015; 42(4):337-44. [DOI:10.1188/15.ONF.337-344] [PMID]
29. Bekteshi V, Kayser K. When a mother has cancer: pathways to relational growth for mothers and daughters coping with cancer. Psycho‐Oncology. 2013; 22(10):2379-85. [DOI:10.1002/pon.3299] [PMID]
30. Kian F, Etemadi O, Bahrami F. Exploring parenting styles of insecure Iranian mothers. Early Child Dev Care. 2019:1-8.
31. Kuswanto CN, Stafford L, Sharp J, Schofield P. Psychological distress, role, and identity changes in mothers following a diagnosis of cancer: A systematic review. Psycho‐Oncology. 2018; 27(12):2700-8. [DOI:10.1002/pon.4904] [PMID]
32. Mazzotti E, Serranò F, Sebastiani C, Marchetti P. Mother-child relationship as perceived by breast cancer women. Psychology. 2012;3(12):1027. [DOI:10.4236/psych.2012.312154]
33. Sadeghi E, Gozali N, Tabrizi FM. Effects of energy conservation strategies on cancer related fatigue and health promotion lifestyle in breast cancer survivors: A randomized control trial. Asian Pac J Cancer Prev. 2016; 17(10):4783-90.
34. Helseth S, Ulfsæt N. Parenting experiences during cancer. J Adv Nurs. 2005; 52(1):38-46. [DOI:10.1111/j.1365-2648.2005.03562.x] [PMID]
35. Öhlén J, Holm AK. Transforming desolation into consolation: Being a mother with life-threatening breast cancer. Health Care Women Int. 2006; 27(1):18-44. [DOI:10.1080/07399330500377226] [PMID]
36. Semple C, McCaughan E. Family life when a parent is diagnosed with cancer: Impact of a psychosocial intervention for young children. Eur J Cancer Care. 2013; 22(2):219-31. [DOI:10.1111/ecc.12018] [PMID]

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