Currently, there are few studies which examine targeted family-focused support when a family member is diagnosed with breast cancer. Thus, the aim of this study was to explore families' experiences of participating in a family nursing intervention identified as Brief Family Health Conversations (BFamHC) following the diagnosis of breast cancer. Semi-structured family interviews were conducted with nine families (including 29 family members) 2 weeks following the family-focused intervention of three sessions of BFamHC. Thematic analysis was used to analyze the data. Families reported the BFamHC as positive and as a unique kind of family health conversation, one that afforded them the opportunity to communicate and share their experiences as a family group. A family conversation, even one as time-limited as BFamHC, offered a sense of relational sharing and togetherness, thus preventing feelings of isolation and vulnerability. Therapeutic family-focused conversations, such as BFamHC, hold promise as a useful family nursing intervention following the diagnosis of breast cancer.

This thesis focuses on women diagnosed with breast cancer and their familymembers. Since a breast cancer diagnosis and its subsequent treatment are astrenuous experience not only for the woman afflicted but also for her familymembers, this thesis aimed to explore the experiences of everyday life duringradiation therapy from the perspectives of the woman with breast cancer andher family, as well as exploring families’ experiences of participating in shortfamily health conversations (SFamHC).All included studies were interview studies (Papers I, II, III & IV), where 30women (20 in Paper I and 10 in Paper II) with breast cancer, 19 family membersincluding the women with breast cancer (Paper III) and 9 families (PaperIV) were interviewed. The data from the interviews was analysed using qualitativecontent analysis (Papers I & II), a hermeneutical phenomenologicalmethod (Paper III) and thematic analysis (Paper IV). The women’s experiences of breathing adapted radiation therapy (BART)(Paper I) were identified in an overall theme, The breath of life, as the womenexperienced the breathing as a way to influence their treatment andthus their survival. The overall theme could be divided into one main category:Participating in one’s treatment, for good or ill, with four subcategories:Knowing one has done something good, Getting an extra bonus –healthwise, The experience of being in control and Being in a hightechnologyenvironment.Women born in Iraq and the former Yugoslavia, diagnosed with breast cancerand living in Sweden, experienced their everyday life during radiation therapyas a narrow and challenging treatment road to survival (Paper II). Theirexperiences were structured into three categories: Strategies for survival, Keepingup appearances and Staying in control. More focus should be on acknowledgingthe woman behind the diagnosis, regardless of her origin, in order to develop individualised support programmes to help women cope with everydaylife during radiation therapy.The families’ lived experience when a family member is diagnosed withbreast cancer (Paper III) was described as a challenging endeavour to regain anordinary, safe life, hoping to reach a safe haven. The families felt that life as theyknew it had disappeared and they were fumbling in the dark and pursuing balanceby struggling to keep the family together and by maintaining a positive attitude.They were also struggling with guilt and inadequacy, due to their difficultiesin communicating emotional distress and to feeling abandoned by thehealth care professionals.Families’ experiences of participating in short family health conversations(SFamHC) (Paper IV) were identified in four key themes: Bringing everythingout in the open, Being confirmed as an individual and as a family, Gaining anunexpected insight and Timing and context matter. The findings from this thesis can deepen the understanding of what livingwith breast cancer is like, from the perspectives of the women with breast cancerand their families, as well as increasing the understanding of their needs.Their experiences could be described as a journey for survival, a journey thatstarts at the time of diagnosis and that they are still partaking in when concludingtheir radiation therapy treatment. The journey for survival sends themoff into the unknown, where they strive to regain control, balancing betweenhope and despair, experiencing their life as divided into an outer and innerworld and needing support from each other as well as from health care professionals.A possible way to support the women and their family members couldbe to offer them participation in short family health conversations (SFamHC),since these conversations provide them with an opportunity to verbalise andshare their feelings and thoughts. Those participants (Paper IV) who took partin SFamHC felt that their participation in the SFamHC helped them to moveforward and beyond the breast cancer diagnosis.

This study aimed at exploring how women from Iraq and the former Yugoslavia, diagnosed with breast cancer and living in Sweden, experience their everyday life during radiation therapy. A qualitative research design was used comprising interviews with ten women, five originating from Iraq and five from the former Yugoslavia. Striving to survive, the women experienced their everyday life during radiation therapy as extremely challenging. This experience can be placed into three categories: strategies for survival, keeping up appearances and staying in control. Because of these specific challenges, immigrant women may need additional information and guidance in conjunction with the diagnosis, which may enable them to identify possible sources of support from those closest to them. Also, greater attention should focus on acknowledging the woman behind the diagnosis, regardless of her origin, to develop an individualised support programme to help her cope with everyday life during radiation therapy.

BACKGROUND: The patient's perception of external radiotherapy (RT) procedures and equipment is important to evaluate as a complement to endpoints such as treatment outcome and reproducibility. There is a lack of a proper, psychometrically robust instrument to evaluate the patient's comfort and experience of the external RT procedure. Hence, this study aimed to develop and test an instrument to measure the patient's experience during external RT.

MATERIAL AND METHODS: A preliminary 34-item questionnaire was generated from research literature, expert consultations and patient interviews, and it was distributed to patients (n = 825) at 8 RT units in Sweden. The answers were subjected to item analysis and reduction by using exploratory factor analysis. The reliability of the final questionnaire was evaluated using Cronbach's alpha. Mean scale scores were compared across gender, length of RT and treatment area.

RESULTS: Most items were highly skewed towards positive responses. Scree plot analyses of the 34-item correlation matrix identified six underlying themes explaining 68% of the total variance. After item reduction, the 6 themes explained 73% of the variance in a 23-item questionnaire. Cronbach's alpha was satisfactory for all themes (between 0.79 and 0.9). Significant differences between treatment areas were found for two scales: situational unease and situational repose.

CONCLUSION: The RT Experience Questionnaire is a tentatively valid and reliable instrument to measure how patients experience the external RT session process and the environment in the treatment room.

Purpose: When a woman is diagnosed with breast cancer, it affects all family members. Therefore, the aim of this study was to elucidate family members lived experience when a family member is diagnosed with breast cancer. Method: The study had a hermeneutic phenomenological design including individual conversational interviews conducted face-to-face with six women with breast cancer and their family members at two different points of time, in order to elucidate families' lived experience, both as individuals and as a unit, from each family member's perspective. Results: Living as a family in the presence of breast cancer is a challenging endeavour to regain an ordinary, safe life, hoping to reach a safe haven. The families felt that life as they knew it had disappeared and they were fumbling in the dark, trying to find support and guidance on their path to ordinary life. The family members were pursuing balance by attempting to keep the family together and maintaining a positive attitude while battling against fear and treatment-related side effects. Finally, the families were struggling with guilt and inadequacy, due to their difficulties in communicating the emotional distress that the illness brought upon them, at the same time as they felt abandoned by the healthcare professionals. Conclusions: Families experience an unmet need of information and support, which implies that healthcare professionals may want to acknowledge and include the family already at the time of diagnosis in order to help them endure and cope with the distressing experience and thus increase their wellbeing.

Purpose To describe and analyze how women with breast cancer experience breathing adapted radiation therapy (BART) and to explore how women manage daily radiation therapy. Method Individual interviews were conducted with 20 women treated with BART for breast cancer concerning their perception of radiation therapy. The transcribed interviews were analyzed using qualitative content analysis. Results ‘The breath of life’ was the overall theme, as the women experienced the breathing as a way in which to influence their treatment and thus their survival. ‘Participating in one's treatment, for good or ill’, was the main category with four subcategories, ‘Knowing one has done something good’, ‘Getting an extra bonus – healthwise’, ‘The experience of being in control’ and ‘Being in a high-technology environment’. The breathing technique became the strategy by which they could manage their treatment and gave them a sense of participation which led to a feeling of being in control. The women also felt that breathing benefited their health both mentally and physically. The high-technology environment was experienced as both hopeful and frightening. Conclusion Survival or increasing the chances of survival, are of ultimate importance for a woman with breast cancer. BART requires commitment from the women, which was perceived as offering them an opportunity to participate in their own treatment, for their survival. Increasing the women's possibilities to participate in their treatment benefits their health and welfare during an otherwise turbulent time and allow the rehabilitation process to start during treatment.