Health-related quality of life among women living with breast cancer in Ghana.
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Background: Health-related quality of life has become an important determinant of the effectiveness of medical treatments among persons living with chronic illnesses including breast cancer. Living with breast cancer is associated with several physical, psychosocial and economic challenges that could negatively impact on the health and wellbeing of women receiving treatment for breast cancer. Breast cancer in the second most diagnosed cancer type among women in Ghana and has several implications for the health of these women due to late diagnosis. However, there is lack of comprehensive social science evidence on the health-related quality of life and its associated factors among women living with breast cancer in Ghana. This study examined the predictors of health-related quality of life among women living with breast cancer and further explored the lived experiences of the women with regards to their challenges, illness representation, coping strategies and healthcare satisfactions. Methods: An explanatory sequential mixed method was employed where quantitative data collection precedes qualitative data collection. For the quantitative phase, a total of 205 women living receiving treatment for breast cancer at a Tertiary Hospital in Ghana were conveniently sampled and administered a set of questionnaires measuring the study variables. For the qualitative phase, a total of 11 women were purposively and conveniently sampled. Individual in-depth interviews were conducted with the participants using a semi-structured interview guide. Descriptive statistics, Pearson Product Moment correlations, multiple regression and mediational analyses using PROCESS were used to analyse the quantitative data whereas the interpretative phenomenological approach was used for the qualitative data analyses. Results: Quantitative results showed that access to health information, health literacy, shared decision making, doctor-patient relationship, social support, having a fighting spirit, the use of cognitive avoidance and fatalistic attitude were significant protective factors for improved quality of life. On the contrary the depression, anxiety, the use of hopeless-helpless coping and anxious preoccupation were significant risk factors for poor quality of life. These predictors had both direct and indirect effects on quality of life among the women through other variables. Findings from the qualitative analyses showed that bio-psychosocio-economic challenges such as the burden of medical treatment, alternative/herbal medicine use and breast cancer stigma were the major lived experiences of the women. There was general inadequate knowledge and understanding of breast cancer. Spirituality, social support, diversion coping and breast cancer self-care practices were identified as the main coping strategies among the participants. There was a varied perception about the satisfaction with interaction and communication with the healthcare professionals. Conclusion: The findings from this study suggest that there are several and complex interlinked challenges faced by women living with breast cancer. These challenges could negatively impact on the health and wellbeing of these women if a holistic approach with professionals from different health disciplines to address their needs. The findings underscore the need for cost-effective cognitive-based psychosocial interventions to deal with the psychosocial challenges which affect their emotional states and ultimately their health-related quality of life.