Intimate partners’ participation in risk-management decision making by women at elevated risk of breast cancer: An exploratory qualitative study

Women at high risk of breast cancer (BC) can face difficult decisions about their risk-management options. For partnered women, a significant other is often the closest emotional relationship and can thus be particularly influential in risk-management decision making. Using data from semi-structured interviews with 30 women in the United States who are at elevated BC risk and in long-term relationships with male partners, we aimed to understand the communication and support-related dynamics of women and their partners. Inductive analysis guided by a constructivist grounded theory approach yielded five main themes. Our results suggest that relationships may add considerable complexity to risk-related decision making. Open communication may be difficult and can be delayed for several reasons: lack of urgency on the part of the woman, reluctance on the part of the partner, or avoidance of uncomfortable topics. Intimate partners often did not fill women's need for emotional support, and some women received support only after difficult conversations or communication assistance from a healthcare provider. Supplemental analysis of women's stories after completion of this inductive work allowed us to posit four approximately sequential levels of partners' involvement in risk-management decision making and action. It was more common for male partners to have no, low, or moderate involvement in risk management, and rarer for men to have a high level of involvement.