Writing the Unspeakable: Breast Cancer Survivors' Experiences of Expressive Writing as Psychosocial Support

To explore breast cancer survivors' experiences of facilitated expressive writing as psychosocial support in Al-Ahsa, Saudi Arabia, and to understand how writing contributed to emotional processing, identity reconstruction, social reconnection, and meaning-making.

A qualitative study informed by reflexive thematic analysis was conducted with 25 breast cancer survivors recruited from oncology and survivorship services at King Faisal University Hospital, Al-Ahsa. Eligible participants had completed active treatment at least 6 months before enrolment and had attended at least three facilitated expressive writing sessions. Semi-structured interviews were conducted between February and April 2025, audio-recorded, transcribed, translated where required, and analyzed using Braun and Clarke's six-phase approach. Trustworthiness was supported through member checking, reflexive journaling, peer debriefing, audit trail documentation, and thick description. Four themes were generated: "The Page That Does Not Judge," which captured writing as a private space for expressing fear, grief, anger, and culturally constrained emotions; "Reclaiming the Self Beneath the Scar," which described reconstruction of body image, femininity, and personal agency after cancer treatment; "From Isolation to Witness," which illustrated how voluntary sharing transformed private distress into relational recognition and social reconnection; and "Growing Through the Written Word," which reflected meaning-making, posttraumatic growth, and spiritual reintegration through Islamic concepts including sabr, tawakkul, shukr, and du'a.

Facilitated expressive writing was experienced by Saudi breast cancer survivors as a culturally acceptable, meaningful, and accessible form of psychosocial support. Participants described writing as facilitating emotional expression, reconstruction of identity after cancer treatment, social reconnection, and spiritually grounded meaning-making during survivorship.

Oncology nurses may incorporate facilitated expressive writing as an adjunct to survivorship care, particularly for patients who experience difficulty verbalizing cancer-related emotions or psychosocial concerns. Structured writing opportunities, combined with voluntary sharing and culturally sensitive facilitation, may provide a low-cost approach to supporting emotional disclosure, identity reconstruction, relational connection, and spiritual meaning-making among breast cancer survivors.