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.
 
 

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.

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.
 
 

The authors declared no conflict of interest.