Supportive Care Needs and Patient Preferences Across the Treatment Journey Among Women with Stage III-IV Breast Cancer in Urban and Rural Tasikmalaya, Indonesia: A Qualitative Study.

内容摘要

To explore supportive care needs and patient preferences among women with stage III-IV breast cancer across the entire treatment journey, specifically examining how the urban-rural context shapes these experiences in Tasikmalaya, Indonesia. This qualitative study recruited 10 women with stage III-IV breast cancer receiving routine care (chemotherapy, hormonal therapy, and/or follow-up) at Jasa Kartini Hospital, Tasikmalaya. Participants were purposively sampled. Data were collected through semi-structured in-depth interviews (audio-recorded) and field notes. Reflexive thematic analysis was conducted following Braun and Clarke. Reporting was guided by the COREQ checklist. Participants experienced treatment delays ranging from 1 to 6 years. Five key findings regarding supportive care needs and preferences were identified: (1) a critical need for credible education to address chemotherapy fears and health-system confusion; (2) a strong preference for psychosocial support through family accompaniment and peer-survivor networks; (3) a reliance on spiritual support (e.g. prayer and dhikr) for hope and acceptance; (4) urgent practical and non-medical financial needs (transport and logistics) that persist despite national insurance coverage; and (5) a dynamic shift in psychological experiences, moving from early distress toward death preparedness and acceptance. Supportive care needs among women with advanced breast cancer are dynamic and significantly moderated by the urban-rural divide, which creates distinct logistical and non-medical economic hurdles even under universal health coverage. Oncology nursing practice should transition toward phase-sensitive care models that prioritize patient navigation to address "hidden" financial burdens and integrate culturally sensitive spiritual support to enhance patient resilience and treatment continuity throughout the complex illness trajectory.