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SPIRITUALITY/RELIGIOSITY AND SUPPORT NETWORK IN THE

PERCEPTION OF WOMEN WITH BREAST CANCER

ORIGINAL ARTICLE

CARVALHO, Simone Meira1, SOUZA, Karine Soriana Silva de2, FERREIRA, Mariana
Barbosa Leite Sérgio3, SANTOS, Maíra Aparecida dos4, BITTENCOURT, Jaqueline
Ferreira Ventura5, GRINCENKOV, Fabiane Rossi dos Santos6

CARVALHO, Simone Meira. et al. Spirituality/religiosity and support network in

the perception of women with breast cancer. Revista Científica Multidisciplinar
Núcleo do Conhecimento. Year. 08, Ed. 04, Vol. 03, pp. 61-77. April 2023. ISSN: 2448-
0959, Access link: https://www.nucleodoconhecimento.com.br/health/perception-of-
women, DOI: 10.32749/nucleodoconhecimento.com.br/health/perception-of-women

ABSTRACT

The diagnosis of breast cancer triggers an emotional impact, generating a variety of

feelings. Spirituality and religiosity and support from family, friends and professionals
is fundamental in coping with this period of adversity. The objective of this study was
to understand how women's spirituality and social support network help in coping with
the diagnosis of breast cancer. This is a qualitative study, carried out in an oncology
hospital, with the participation of forty women with breast cancer. For data collection,
semi-structured interviews were applied, analyzed using Content Analysis. The
thematic axis “Support” was composed of the categories “Spirituality/Religiosity” and
“Social support”. Faced with the discovery of a disease that leads to suffering and
death, a support network is needed to cope with cancer. Spiritual support was
unanimous and faith favored overcoming the initial impact, infusing strength to face the
diagnosis. The family represented a unique support, helping with health care and with
words of encouragement. Professional support occurred through guidance, kindness
in assistance and motivation. The pandemic has impacted social isolation. However, it
brought benefits such as greater contact with the family. To cope with the cancer
diagnosis, the women studied had social and spiritual support, through emotional
support, material and practical resources, received from family members and
significant others. These are strategies that need to be explored by the multidisciplinary
team at the time of diagnosis, minimizing the impact and accepting the demands
presented by women with breast cancer.

Keywords: Spirituality, Social Support, Breast neoplasm, Women's health.

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1. INTRODUCTION

The discovery of breast cancer affects women's lives, triggering an emotional impact,
permeating various feelings (KUGBEY; ASANTE; MEYER-WEITZ, 2020), from
perplexity, stress, anguish and insecurity (AHMED; ELGHOBASHY; IBRAHIM, 2022).
After the diagnosis, myths related to death are awakened, giving rise to feelings of
denial and suffering (LOPES; CAMARGO; MAIA, 2020; ALVES et al., 2021).

In the meantime, women need support from family and friends, while they seek to
understand the illness and face the treatment. Social support brings benefits in coping
with illnesses and promoting health (LOPES; CAMARGO; MAIA, 2020; KUGBEY;
ASANTE; MEYER-WEITZ, 2020). Religiosity and Spirituality (R/S) also act as support
and motivation factors to help in understanding and coping with the disease (ARAB et
al., 2016; AHMED; ELGHOBASHY; IBRAHIM, 2022). Likewise, adequate professional
monitoring is necessary, covering the physical, psychosocial and cultural aspects of
the illness process (SILVA et al., 2020)

The support network for women has been highlighted as an integral part of breast
cancer treatment, providing support, comfort and collaborating in the various
dimensions of their lives that are drastically impacted by the diagnosis (LOPES;
CAMARGO; MAIA, 2020; ADAM; KORANTENG, 2020). This support network is made
up of family, friends and health professionals and works as emotional support or
through information, significantly reducing the stress resulting from the diagnosis of
breast cancer and increasing emotional well-being (ADAM; KORANTENG, 2020).

For Lopes, Camargo and Maia (2020), spiritual support, arising from religious
affiliations or from faith itself, instills strength and support in situations of adversity,
favoring acceptance and the process of coping with the disease. Although authors
recognize the importance of R/S as a source of support in coping with breast cancer,
in Brazil there is still a low scientific production on the subject (ARAB et al., 2016;
ALVES et al., 2021).

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This research aims to collaborate with health professionals in understanding the

factors that help to cope with breast cancer to serve as a tool to improve clinical
practice. In this context, the aim was to apprehend how R/S and the social support
network of women affected by breast cancer help in coping with the diagnosis.

2. DEVELOPMENT

2.1 METHODS

A descriptive exploratory study, with a qualitative approach, was carried out in an

oncological hospital, in Juiz de Fora, Minas Gerais, addressing 40 women with breast
cancer, to understand how the spirituality and social support network of women
affected by breast cancer help in coping with the diagnosis of the disease. The
presentation of the study was guided by the Consolidated Criteria for Reporting
Qualitative Research (COREQ) guidelines.

2.1.1 SAMPLING AND SAMPLE

The intentionality sample consisted of women diagnosed with breast cancer

undergoing chemotherapy at the referred hospital. To enter the study, inclusion and
exclusion criteria were selected according to Figure 1.

Figure 1. Participant inclusion and exclusion criteria

Source: prepared by the authors.

The approach was carried out in the chemotherapy sector. As there was no previous
contact with patients in the chemotherapy sector, the patients' records were evaluated

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and selected according to the research criteria, indicating which women were being
treated for breast cancer. Those who fit the criteria were invited to participate in the
study, explaining the objectives by reading and clarifying the Term of Free and
Informed Consent (TCLE)[7].

2.1.2 DATA COLLECTION

An individual interview with a semi-structured script was used for data collection,
containing sociodemographic and clinical data, as well as questions about the
discovery of cancer, treatments and self-care guidelines. The script was appreciated
by health professionals and tested by a pilot project. The interviews lasted 20 minutes
on average. They were recorded, transcribed and reviewed by the main researcher,
who has experience in qualitative health research. Collection was carried out from
January 2020 to February 2021, with an interruption between March and October
2020, due to the pandemic. The saturation criterion was observed through the
repetition of reports, totaling 40 interviews.

2.1.3 DATA ANALYSIS

Bardin's Thematic Content Analysis was used to evaluate the qualitative data. This
analysis consists of a set of techniques that aim to analyze and infer about the content
of the messages identified in the interviews. To organize the data and define the
categories, three stages were followed: the first, pre-analysis, aimed at organizing the
transcripts of the interviews, formulating hypotheses through skimming reading and
elaborating theme indicators; in the second, exploration of the material, the codification
of the registration units and the categorization of the nuclei of meaning were carried
out; finally, the treatment and interpretation of the results were carried out. At this
stage, the inference and interpretation of the results were carried out, seeking a basis
in theory to understand the meaning of the messages (BARDIN, 2016).

The medical records were accessed to complement the participants' data. All data
collection, analysis and categorization was performed by the main researcher, using
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the conventional manual method. The final themes were discussed with the other
authors. Quotes from interviews were used to represent each category. The stages of
recruitment, data collection and analysis are shown in Figure 2.

Figure 2. Data collection and analysis flowchart diagram

Source: prepared by the authors.

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2.1.4 ETHICAL ASPECTS

This article is part of an ongoing doctoral research. The study was approved by the
Research Ethics Committee of the Universidade Federal de Juiz de Fora (CAAE
16104219.8.0000.5147, version 3, opinion nº 3.649.430), on 10/18/2019. Ethical
aspects were observed in the study procedures, according to Resolution No. 466, of
December 12, 2012, of the National Health Council/Ministry of Health. The
interviewees were identified by the letter E, followed by Arabic numerals, aiming at
privacy.

2.2 RESULTS

The participants' age range ranged from 31 to 77 years, with a predominance of brown
color/race (42.5%), incomplete elementary school level (35.0%) and complete
secondary school (35.0%), and half on sick leave (50%). Most of the women were
married (37.5%) and had a family composition of three people (37.5%). There was a
prevalence of the Catholic religion (72.5%). The other data are presented in Table 1.

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Table 1. Sociodemographic characteristics (n=40)

Source: prepared by the authors.

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The analysis of the content of the interviews led to the emergence of registration units,
which gave rise to the thematic axis “Support”, from which the thematic categories
“Spirituality/Religiosity” and “Social Support” emerged, expressed below.

2.2.1 SPIRITUALITY/RELIGIOSITY

The support found in spirituality and religiosity was cited by all women in the present
study. Faith contributed to overcoming the impact of the diagnosis, favoring
acceptance and inspiring them to face a disease shrouded in myths, through the
courage and strength found in faith.

A minha fé, crer em Deus. Ele quem está me ajudando muito. Se

não fosse isso, a gente acaba caindo em depressão, porque
enfrentar essa doença não é fácil (...) (E30).

É Deus mesmo que está me ajudando. Porque, eu não esperava

ser tão forte assim. A fé em Deus me dá forças (E16).

Faced with illness, women find comfort in faith, which instills hope at a time when
negative emotions arise. E/R is an important tool that helps in a positive coping
process.

O médico falou (...): “tem gente que chega aqui já desespera,

fala que já vai comprar o caixão, chora muito”. Eu não, não me
desesperei por nada. (...) Entrego tudo na mão de Deus (E29).

Depois que eu descobri esse diagnóstico, Deus foi colocando

um refrigério na minha alma: “vai dar tudo certo” (E31).

All interviewees consider S/R, as they say, “God”, as a primary source of support,
coming before the social support of family, friends and health professionals.

Primeiro lugar é Deus. Tenho recebido muito apoio da minha

família também e de vizinhos. Até as pessoas daqui mesmo [do
hospital] (E12).

Primeiramente é Deus, que dá força à gente. Aí depois tem os

médicos e os familiares da gente (E15).

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The COVID-19 pandemic presented itself as a barrier to the maintenance of

community religious activities. However, the flexibility offered by electronic media
facilitated virtual participation.

Meu primo queria ir lá em casa. Tem que ir mais uns dois servos
para fazer oração. Mas com a pandemia, não deu (E30).

Me apeguei muito a Ele [Deus]. (...) Agora, não vou mais à missa
por causa da pandemia. Mas eu faço muita oração, assisto
missas “on-line” e estou rezando muito terço. E tem me ajudado
bastante (E13).

Attributing meaning to suffering reinforces women's self-esteem. Even in a difficult

situation, they find vigor in the search for treatment of the disease and infect those
around them.

Minha sobrinha vai à minha casa e fala que eu passo muita

alegria, mesmo enfrentando esse problema. Ela fala que vai me
visitar e sai feliz, porque eu passo força para ela (E34).

Eu gosto de viver. Porque a gente tem que se gostar, querer

estar bem [...] para poder continuar. Se não estivermos bem, não
têm como ajudar ninguém, não tem como fazer nada (E35).

2.2.2 SOCIAL SUPPORT

The family proved to be an important source of support for all research participants.
Through assistance in health care, affection and words of encouragement, the support
of this support network alleviates suffering and is the driving force to endure treatments
and fight for life.

Uma coisa importante, que ameniza demais, é o carinho dos

familiares, o amor e o cuidado (E7).

Uma [irmã] em especial, que sempre esteve comigo em todos os

momentos, é a minha fortaleza. A família, amigos, me ajudaram
muito (E37).

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However, social support can also be perceived negatively. This perception may be
influenced by several factors, mainly the difficulty in dealing with the illness of a family
member.

Minha família é maravilhosa, só que eles não me acompanham

de perto. Eles lá e eu aqui (E25).

Depois que descobri esse câncer (...). Faz diferença sim, tem a
carência. O apoio não é só pagar as contas, mas tem o apoio de
mais presença. Isso eu sinto falta (E26).

Regarding social support from family and friends, geographic distance and the need
for isolation due to the pandemic were critical obstacles, due to the need for social
isolation to avoid contamination by the coronavirus. In the midst of these barriers,
family members sought ways to overcome the distance, playing an important role in
supporting women.

Às vezes a pessoa tem até vontade de ir fazer uma visita, mas

fica com medo por conta da pandemia, devido à possibilidade de
eu pegar [coronavírus] (E33).

Minha filha que mora na Inglaterra, ela soube [do câncer]: “nem
que eu tenha que ir comprar a passagem no cartão, vou dar um
jeito de ir ver minha mãezinha” (E21).

On the other hand, the pandemic also brought closer family relationships, due to the
interruption of work and student activities, in addition to the removal of women from
their activities due to the treatment.

Minha filha estava com cinco meses e eu continuei trabalhando.

Agora, com esse negócio de pandemia, que descobri o câncer,
que eu estou ficando mais em casa com ela (E28).

Por causa da pandemia, não está tendo aula, então, ele [filho]
fica do meu lado. Tudo que eu falo, ele me dá atenção (E35).

The support network of the women in the present study was constituted, in addition to
the family, by friends, neighbors, co-workers and people from social life. This network
works as support in a moment of fragility.

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Tenho muitas amigas da igreja. Elas vão me visitar! Minha

casinha tem dias que fica cheia (risos) (E6).

Minha amiga de infância. (...) a mãe dela teve câncer e faleceu

no ano passado. Mesmo com esse período difícil, ela tem me
apoiado muito (E7).

Electronic media played an important role in overcoming the barriers of distancing,

especially in the pandemic period, highlighting benefits such as approximation,
strengthening of bonds and the courage to face the illness.

Minha mãe me dá suporte em palavras, (...) pelo “whatsapp”. As

palavras e o carinho das pessoas me deixam animada (E11).

Entrei agora em um grupo [da igreja], pelo celular. Estou

seguindo e tem me ajudado bastante (E23).

Another source of support was that of health professionals, identified through attention,
affection, good service, enlightening approach. The participants reported that these
characteristics brought benefits such as safety and motivation.

Estou sendo bem tratada, seja pelos enfermeiros, os médicos e

as meninas da recepção, todos são agradáveis, tratam a gente
com carinho (E11).

O tratamento aqui [no hospital] é muito bom, o pessoal

[profissionais de saúde], são todos muito bons, explicam tudo
direitinho. Isso é muito importante (E25).

In the interviews, it was noticed that few participants received assistance from other
professionals, including the importance of the psychologist. Only five women had
contact with this professional.

Como te falei antes, o psicológico é muito importante (E7).

E a questão psicológica, na qual eu recorri ajuda. Às vezes

precisamos conversar sobre essa questão [câncer]. Porque, tem
dias que você só quer chorar, chorar, no outro dia você fica bem
(E37).

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2.3 DISCUSSION

Faced with the peculiarities of illness from cancer and the beliefs that trigger significant
changes in lifestyle, the possibility of death and reflections on the meaning of life, R/S
is a powerful tool in the coping process (SILVA et al., 2020; AHMED; ELGHOBASHY;
IBRAHIM, 2022). In the research, R/S was present in the experience of all participants.
Other research has shown that women used R/S to better cope with the illness
(VARGAS et al., 2020).

By bringing with it feelings, decisions and deep reflections, adversities favor the pursuit
of R/S, which becomes intensified in those moments when human beings are faced
with their fragility (ALVES et al., 2021; SILVA et al., 2020 ; AHMED; ELGHOBASHY;
IBRAHIM, 2022). In the present study, women sought relief, comfort and strength in
their attachment to God, which helped in the acceptance process, minimizing negative
impacts (FERREIRA et al., 2020; ALVES et al., 2021).

It was verified that the R/S contributed to the experience in the community of faith,
which instills a hopeful look at the illness situation, corroborating other studies, which
claim that women see God as someone who relieves suffering (BORGES; ANJOS;
CAMPOS, 2021; FERREIRA et al., 2020; VARGAS et al., 2020).

Another factor highlighted in the present study was the emergence of reflections on
life, its meaning and way of living it. The attribution of a new meaning to suffering was
also present, allowing the establishment of priorities and future goals (MOKHTARI et
al., 2021; AHMED; ELGHOBASHY; IBRAHIM, 2022).

With regard to social support, women perceived support from family and friends,
manifested in the form of material resources, advice and affection, as a source of
protection and strength to face adversity, a fact also verified by other authors (ADAM;
KORANTENG, 2020 ; ARAB et al., 2016). Families are the closest support system,
establishing themselves as an important factor in coping with and managing the
disease (VARGAS et al., 2020; MOKHTARI; MARKANI; KHALKHALI, 2021).

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On the other hand, situations were observed in which the woman does not perceive
herself to be met in some need, such as, for example, the emotional one due to
distancing. It is noteworthy that the family is also impacted, experiencing feelings of
concern, fragility and uncertainty, which negatively influence relationships
(FIGUEIREDO et al., 2017). Thus, it is relevant to include the family in the treatment,
preparing them for the care and support of women diagnosed with cancer (LOPES;
CAMARGO; MAIA, 2020).

Due to the need for social isolation, the pandemic triggered socioeconomic impacts on
physical and mental health and, consequently, on quality of life (MASSICOTE; IVERS;
SAVARD, 2021), especially in cancer patients, who are already dealing with physical
and mental changes resulting from the treatment (MARÇAL; VAZ, 2022). In addition to
the concern with the prognosis, social distancing impaired the functioning of the
support network, imposing difficulties in contact with family and friends (CORRÊA;
OLIVEIRA; TAETS, 2020). On the other hand, there were positive points brought by
the “lockdown”, considering that a greater availability of time allowed the approximation
of some family ties.

The support of health professionals is also of great importance for coping with cancer
(MOKHTARI et al., 2021), whether emotional or informative. The present study showed
that both provide greater emotional stability and knowledge about the treatment
(ADAM; KORANTENG, 2020). In the present research, few women had contact with
the psychologist. In the meantime, it is essential to highlight the importance of
comprehensive care for women with cancer, covering not only physical aspects, but
also social, psychological and spiritual aspects (LOPES; CAMARGO; MAIA, 2020).

3. FINAL CONSIDERATIONS

Faced with the repercussions of the diagnosis of breast cancer on women's lives, R/S
has been a priority coping resource, helping in the process of accepting the diagnosis.
It also contributes to social support by providing community experience.

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Faced with the emergence of reflections related to the meaning of life and the way of
living it, the R/S helped in attributing new meanings to the suffering experienced. The
social support received from family and friends, as well as the emotional and
informational support received from health professionals, played an important role.
Such coping mechanisms become preventive and health-promoting strategies that
should be explored by the multidisciplinary team, aiming to minimize the emotional
impact of the diagnosis of women affected by breast cancer.

3.1 LIMITATIONS

The study had limitations regarding the sample recruitment method. Choosing for
convenience can bring with it possible selection biases. As it is restricted to only one
cancer hospital, it does not allow the results to be generalized to the population of
patients studied. As for the number of participants, research with a qualitative approach
covers a limited number of interviews, since the understanding of a phenomenon or
event does not need to be quantified. However, the depth of this data collection
instrument is usually sufficient to achieve the proposed objectives. It is also necessary
to demarcate that the results found by the qualitative study are not subject to statistical
generalizations, but naturalistic ones. The cross-section used prevents the evaluation
of the impacts of the event under study in the long term.

3.2 FUTURE COLLABORATIONS

This research offers the possibility of future studies that deeply investigate R/S and
social support in women at the time of diagnosis, such as the effects of these
experiences, in the long term, on the socio-emotional impacts of the news of the
diagnosis.

Some repercussions of the COVID-19 pandemic were seen in the experience of the
investigated resources. Thus, follow-up studies are needed to investigate the greater
repercussions of this event on the use of these coping resources.

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In view of the role assumed by R/S and social support in coping with women at the
time of diagnosis, it is extremely important that the health team uses such resources
in a preventive and promoting way, developing an integral work to address the
biopsychosocial aspects -spiritual, also envisioning the family, caregivers and other
sources of support. For this, the presence of a multidisciplinary team, capable of
providing support to women, is of paramount importance. Emotional support is not
restricted to psychology professionals, since all professionals must use strategies for
this immediate support.

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APPENDIX - FOOTNOTE

7. Termo de Consentimento Livre e Esclarecido (TCLE).

Submitted: February 9, 2023.

Approved: April 06, 2023.

1 Doctoral student in the Graduate Program in Psychology at the Universidade Federal de Juiz de
Fora (graduate in progress); Juiz de Fora (MG), Brazil. Master in Collective Health, by the
Universidade Federal do Rio de Janeiro; Juiz de Fora (MG), Brazil. Graduated in Physiotherapy, by
Centro Universitário Metodista do Instituto Porto Alegre (1987); Porto Alegre (RS), Brazil. ORCID:
0000-0002-7680-131X. Currículo Lattes: http://lattes.cnpq.br/2502447838688845.
2 Specialist in Adult Health, with Emphasis in Chronic-Degenerative Diseases, by the Programa de

Residência Multiprofissional do Hospital Universitário da Universidade Federal de Juiz de Fora

(HU/UFJF). Graduated in Psychology, by the Institute of Human Sciences of the Universidade Federal
de Juiz de Fora; Juiz de Fora (MG), Brazil. ORCID: 0000-0003-3763-6478. Currículo Lattes:
http://lattes.cnpq.br/3483394631182991.
3 Master in Psychology, from the Universidade Federal de Juiz de Fora; Juiz de Fora (MG), Brazil.

Specialist in Cognitive-Behavioral Therapy, by Faculdade Redentor. Graduated in Psychology, from

the Centro de Ensino Superior de Juiz de Fora Juiz de Fora (MG), Brazil. ORCID: 0000-0001-6819-
6482. Currículo Lattes: http://lattes.cnpq.br/1343124968034583.
4 Undergraduate student in Psychology at the Institute of Human Sciences at the Universidade

Federal de Juiz de Fora; Juiz de Fora (MG), Brazil. ORCID: 0009-0000-8439-4024. Currículo Lattes:
https://lattes.cnpq.br/9465882716674784.
77
RC: 146456
Available in: https://www.nucleodoconhecimento.com.br/health/perception-of-women
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5 PhD in Nursing from the Anna Nery School of Nursing at the Universidade Federal do Rio de
Janeiro (UFRJ). Master in Nursing from the School of Nursing of the Universidade Federal de Minas
Gerais (UFMG). Specialization (lato sensu post-graduation) in Occupational Nursing, by the
Faculdade de Enfermagem Luiza de Marillac - Centro São Camilo de Desenvolvimento em
Administração da Saúde (CEDAS). Degree in Nursing and Midwifery from the Universidade Federal
de Juiz de Fora; Juiz de Fora (MG), Brazil. ORCID: 0000-0001-9395-4388. Currículo Lattes:
http://lattes.cnpq.br/8032123272413172.
6 Advisor. Doctor in Health, from the Universidade Federal de Juiz de Fora; Juiz de Fora (MG), Brazil.

Master in Health, Universidade Federal de Juiz de Fora; Juiz de Fora (MG), Brazil. Degree in
Psychology, from the Higher Education Center of Juiz de Fora; Juiz de Fora (MG), Brazil. ORCID:
0000-0003-0948-2635. Currículo Lattes: http://lattes.cnpq.br/0976974025888018.

78
RC: 146456
Available in: https://www.nucleodoconhecimento.com.br/health/perception-of-women