Treatment Decision-Making in West African Women With Breast Cancer: A Critical Ethnography

This study aimed to understand and characterize how culture affected behavior and decision-making about treatment and care in West African women with breast cancer living in the United Kingdom.

A critical ethnographic design was used with a sample consisting of 32 West African women, 27 supporters, and 18 health care professionals. Data were collected through 263 hours of participant observation and 98 informal and 10 formal interviews in a London cancer unit. Study materials and approach were informed by patient and public involvement group recommendations. Data were analyzed using an adapted Carspecken critical ethnographic approach.

Three main themes were developed from the data: cultural knowledge, beliefs, and values; otherness; and cultural curiosity. West African women described a range of meanings and beliefs about their breast cancer diagnoses and treatments. They felt "Other" from, and were seen as "Other" by, their communities and health care teams. The clinical team exhibited varying levels of cultural curiosity, which evolved over time.

Cultural beliefs concerning cancer and its treatment were so strong that they led to some women refusing, delaying, or interrupting treatment. Nurses must seek to understand and value the perspectives and beliefs of people from unfamiliar cultures and consider how services might be made more flexible to meet their specific needs.

By being culturally curious and gaining understanding about how a woman's culture affects decisions about treatment and care, health care professionals began to understand that patients are more able to accept optimum treatment if adjustments are made to the service.