Decision-making for wāhine Māori facing breast cancer surgery: a qualitative study

Abstract

Wāhine Māori (women/females) are disproportionally affected by breast cancer in Aotearoa New Zealand. Following a breast cancer diagnosis, wāhine must make important surgical decisions while navigating a Westernised health system that can be dismissive of Māori views of health and tikanga (customary practices). We investigated the decision-making process of wāhine who had undergone surgery for breast cancer within the preceding 12 months. Fifteen wāhine shared their perspectives on surgery, shared decision-making and information provided prior to surgery. Thematic analysis revealed that fear was a primary influence on decision -making, but this emotion could be mitigated by a good quality patient-clinician relationship fostered by the shared decision-making process. In particular, whakawhanaungatanga (establishing connection and relationships) was an essential basis for shared decision-making. Shared decision-making, in turn, enabled tino rangatiratanga (self-determination) and provided support during the difficult decision-making period. Multi-modal presentation of medical information, with inclusion of Te Reo Māori is relevant to many wāhine and could offer more equitable access to diagnostic information. These findings raise awareness of the importance of recognising tikanga, in particular, whakawhanaungatanga for wāhine Māori diagnosed with breast cancer.

Keywords

• Wāhine Māori
• breast cancer
• indigenous health
• shared decision-making
• tikanga