The Triple Intersection Of Illness,Family,and Gender:Roles And Power In Decision-Making In Couples With Breast Cancer

Breast cancer is one of the most important malignancies affecting women’s health.On the one hand,the number of new breast cancer cases in our country has been increasing in the past ten years.On the other hand,with the innovation and progress of breast cancer treatment methods and diagnosis,breast cancer has become a chronic disease that requires long-term management and care.This intrusive life event is often confronted by a binary collective of patients and their spouses.In this long process,couples with breast cancer will face many decisions,which could have a great impact on the patient and the patient’s family.Therefore,when couples are faced with various decisions in a new situation,they need to take into account the differences and preferences of both parties,and integrate the common ideas of both parties.Otherwise,it will bring about differences and conflicts,and even have a negative impact on the stability of the marriage relationship and family.By exploring the decision-making process of couples with breast cancer patients,it is beneficial to understand the specific decision-making process of couples,decision-making changes in medical situations,interactions and power distribution in decision-making,and the hidden role differences behind them,which can provide data and basis for further intervention and intervention.Therefore,guided by situational interactionism and intersectionality theory,I conducted semi-structured,in-depth interviews with 16 dyads of matched women with breast cancer and their spouses(N=32)in Shanghai.The purpose of this study is to understand the decision-making process of breast cancer patients and their spouses after entering a new medical situation under the background of Chinese social and cultural institutions,and to explore the changes in their decision-making from the perspectives of both patients and spouses.The study found that the decision-making and interaction of breast cancer patients and their spouses changed significantly as the normal rhythm of the family was disrupted after entering a new,treatment-focused decision-making situation.In order to alleviate the fear of unknown situations and improve the quality of life of patients,these new decisions are often developed in the direction of cumbersome and professional.And,thanks to these new and different decisions,couples with breast cancer are given new identities,which requires them to adjust the way they make decisions and the distribution of decision-making power to adapt to the changes brought about by new circumstances and new identities.The power relations of some families are developing towards a more egalitarian direction.However,in more families,the decision-making power of husband and wife has not reached a relatively balanced state,and their distribution of power has moved in the more extreme directions of total dominance and relinquishment.The reason for this extreme mode of power distribution is the communication problem between husband and wife and the individual’s error in self-positioning and power perception.This power distribution pattern stems from the specific interaction and power perception patterns between couples,which can lead to decision-making mistakes and decision-making regrets,weaken the individual’s power in decision-making,reduce their status in the family,and then affect the quality of decision-making and family relationships.Behind the change in the distribution of power is a different understanding of the three roles the couples have.There is a natural unequal hierarchical sequence in the gender roles and family roles generated under Chinese traditional gender distinction and family culture.After entering the disease situation,the couple is given a new medical role on this basis.The superposition and intersection of these three roles affect the generation and direction of power change,and bring about different distribution methods of decision-making power for different families.This may affect the outcome of decision-making and the intimate relationship between the couple,and is not conducive to the harmonious and orderly progress of the decision-making process and the treatment process.Finally,in the process of researching the decision-making of breast cancer patients and their spouses,this study explores the problems and dilemmas they face in the decision-making process.On this basis,it puts forward some ideas and suggestions on micro-intervention and macro-advocacy when medical social workers serve this group,in order to provide more effective and appropriate services for breast cancer patients and their spouses.