Introduction

A diagnosis of breast cancer affects a woman and her family as well. Much research has examined the negative effects of cancer on the family (Huizinga et al. 2011; Karlsson et al. 2013; Patterson and Rangganadhan, 2010; Pusa et al. 2012). Amidst the turmoil of the cancer experience, families may experience silver linings throughout their journey. For example, previous literature has shown that mothers with cancer tend to remain strong and a source of inspiration for their families, in order to help cope with the cancer process (Amir et al. 2012; Asbury et al. 2014; Duggleby et al. 2012; Helseth and Ufsaet 2005). Further, the positive outlooks of wives inspire their spouses and aid them in taking care of their families while they are ill. Additionally, spouses are able to find the courage to continue through the progression of their illnesses (Duggleby et al. 2012). In some cases, courage and support from their wives remains the only factor that aided spouses in persevering throughout the cancer experience (Duggleby et al. 2012).

Additionally, when a mother faces a cancer diagnosis, there is great likelihood for her children to be affected. Kennedy and Lloyd-Williams (2009) and Pusa et al. (2012) contend that going through the cancer experience allows families to be drawn closer together, as well as become more appreciative of their family members and support systems during that time (Pusa et al. 2012; Kennedy and Lloyd-Williams 2009). However, previous research has rarely examined cancer’s effect on one entire family unit. As such, the purpose of this research was to examine the lived experience of a family that lost their spouse/mother/sister-in-law to cancer and focuses on the positive outcomes of the experience.

Methods

A brief synopsis of the methodology will be provided as a detailed description of the methodology used can be found in Part I of this research.

Participants

After ethics clearance was obtained, four participants (one Italian family unit from Southern Ontario; the ‘Miller’s’) were recruited to participate: “Nancy’s” (the deceased) husband, “Dave” (aged 50), his sister “Linda” (aged 53), and his two children “Hannah” and “James” (aged 18 and 14). All participants signed informed consent forms before any data collection occurred.

Procedure

Each participant completed a background questionnaire and a one-on-one, semi-structured interview designed to capture the essence of their experiences. All interviews were conducted by the primary researcher and were either conducted over the phone or in person, based on the level of convenience for the participants. The interviews with Dave, Hannah, and James were conducted at their family residence, while the interview with Linda was conducted over the phone. Field notes were collected throughout the interview process and member checks were completed with each transcript that was transcribed verbatim. Data triangulation was used to increase the credibility of the study via utilization of multiple data methods. Member checks were also employed so that the participants were given the opportunity to edit information presented in their transcripts (Lincoln and Guba 1985, p. 236).

Data Analysis

The most appropriate methodology for this study was qualitative with the theoretical orientation of phenomenology being chosen to guide the research. Patton (2002) comprehensively defined phenomenology as:

How human beings make sense of experience and transform experience into consciousness, both individually and as shared meaning. This requires methodologically, carefully, and thoroughly capturing and describing how people experience some phenomenon –how they perceive it, describe it, feel about it, judge it, remember it, make sense of it and talk about it with others (p. 104).

For the purpose of this study, a single case (or within-site study) was completed, as this family unit would be considered a single case.

In order for the primary researcher to analyze the responses of the participants and understand their lived experiences, data gathered from the background questionnaires were used to provide a framework for the interviews and provided the researcher with context. As well, background questionnaires were also used when reviewing interview transcripts, and in collaboration with field notes to understand and maintain the context at that particular time. Each interview was transcribed verbatim, and all interviews were examined for the recurrence of particular themes, discussion topics, and contrasts.

Results

Background Information

This study examined the positive effects or “silver linings” associated with the “Miller’s” cancer journey. Two sub-themes emerged from the silver linings theme: (1) “…She was remarkable.” and (2) Hope for the future. Each will be discussed in turn.

“She was remarkable.”

Throughout Nancy’s experience with cancer, she was, and always had been, a source of joy for her family. All of her family acknowledged that she was kind and adored by all and her love kept them, as well as their friends, very close. Hannah stated:

Everyone loved her. She’s just, very open, very loving … The family was just very close in general, everyone, was very close with her.

Dave knew that Nancy was his soul mate, which can be depicted by the following quotes:

…she was remarkable. Bottom line, my best friend. She, the, the story where ‘she completes me’? That, that was her. She was remarkable. She was just, really good. Good, good person to be with….

And I-I still, I-I go back ‘cause, I remember saying you know I, I-I know you being with me will be, will be a great life for you. And in the end, it was totally reversed. Her being with me was great for me. Because she was remarkable. Right? And it was, yeah it was just, tough. It was, just amazing to see what kind of person she was.

He also discussed that Nancy had many friends who all loved her dearly.

So they would come and see her, during her crisis. And what was always amazing to me was when I was walking, them out to say bye, you could see they, they were filled with tears, right? So, when they were here, it was all about making her smile. So she had the kind of friends that evoked, that kind of compassion for her.

Linda remembers being extremely close with Nancy as well, and considered her to be like a sister.

Oh fantastic person. Everybody loved her. She could tell. Um, she was just a really nice person. She, got along with everybody, and, always tried to look for the best in people. Um, [pause] she and my brother were fantastic together. She had a great sense of humour.

James, who found it difficult to speak about his mother, was also able to comment on his mother’s positive traits.

She was nice …. all around sweet.

Nancy was dearly loved by her family and friends, and was admired even more for her character.

As her condition worsened, she remained strong—something appreciated by her family. Her inner resolve was evident as she progressed through her illness, which acted as a shining light for her family. Hannah admired this about her mother.

She was a fighter. She never went down without a fight. I think they gave her, two months, and she was like, “fuck that” [laughs] and lasted like, seven months eight months. Um, you never saw her frowning. She was always smiling even when she was in pain which is always something that, I admire, greatly. I don’t know how she did that.

Hannah’s sentiments were repeated by Dave, who believed his wife was stronger than he was.

Well she always seemed more composed than [me]. Um, [pause] you know I-I know a friend of mine has, her mother has cancer now and she talks about, how she doesn’t have that will, to live. And, and I never saw that in Nancy. Nancy was, fight fight fight, smile smile smile, and I was, uh, fight fight fight, sad sad sad. I-it, it was just, very different. Like, a-and but she still brought me up because she had that way.

Like just, that, inner resolve that strength. So even things that I saw from the first time I met her, of how great she was, just a hundred times magnified.

Linda reiterated Nancy’s strength of character.

I was very proud of her. Her struggle was, her ability to fight and her faith was huge like, she was going through so much and uh, to have the faith that she had, was unbelievable like right to the end.

Linda also went on to say that even though Nancy was going through some extremely difficult times, she still found ways to bring humor to the situation and make others feel better, which she appreciated.

She went into septic shock …. Uh, she woke up, and uh [pause, sigh] she was trying to communicate and it would take me a while to figure out that she was sign language-ing with me? …. So we were by ourselves, she would try to sign stuff and I’d, I’d go “okay go slower” and you could see her rolling her eyes at me thinking “ugh”, so when she got that thing off and she finally, I finally saw her after she goes “you fucking suck at—” and like her voice was really scratchy, “you fucking suck at sign language!” And I said “you are so funny. I am so sorry.” So [she] goes “I know you’re brutal at it” and I’m like “I’m brutal I’m sorry!” but we laughed about it afterwards, so.

Nancy was never a burden to her family. Her family marveled at her strength, positivity, and resilience throughout her cancer journey.

Regardless of her condition, she was determined to be there for her children throughout her illness. Dave knew that it became harder for her to do things with the kids as her condition worsened, but he contended that her kids were always her biggest priority.

Well the kids had the Wii, Nancy would love playing Wii with them and stuff. So ‘cause it was something she could do from her chair. And play, so. I-I mean she found a way to keep engaged with them as long as she could. Yeah, w-which was, it made a big difference too. Even for her. Right? To stay active with them.

Linda, as a mother herself, admired Nancy’s determination to make her children happy when she was undergoing such a difficult time. It was something that she respected.

…her commitment to her kids was, was, was huge. I know that when—even when she was sick, un, when she was told that she couldn’t, teach anymore, um, even being at home like she would … she would forego, her, uh cleaning the house and which was very—no big deal in the end, ‘cause, in our family thank your parents for having a clean house, rather, you spend time with them right? Um, she would go and conserve all of her energy so when James got home from school, she would spend, you know she would spend a couple of hours making sure that they got their homework done …. She even went like I said even when she was sick, everything she did every, every decision she made revolved around how it was going to affect, how it would affect um, James and Hannah.

Even when she knew she was dying, Nancy’s priority was her children. She wanted to make sure that they could live the happiest lives possible, even if she was no longer with them. She relayed these thoughts to Linda.

She was like, when she, at the end, [sniff] she was, even though she was struggling and she knew she was gunna die, she was, okay with dying, but she was worried about what was going to happen to the kids and Dave at the end. That was her biggest concern. Like she had already, [sniff] she knew what the outcome was going to be and she knew, she was ready for that. You know she said like she even said “I wasn’t, I’m not, I’m not worried about dying. I’m worried, about the people I’m leaving behind.” And, making sure that they are, taken care of. And that was the way Nancy was. Right?

Her selflessness was a source of inspiration to her family, a silver lining to a household in turmoil, and best summed up by Dave:

…she was pretty strong. I mean [cancer] took her life but it didn’t take her character.

Each person recognized the influence Nancy had on his or her life. While Nancy was a shining light during their experience with cancer, the family experienced other positives as well.

Hope for the future

The family acknowledged that they were hopeful this experience would act as a positive influence on each member in future years. Dave had some hesitations when stating that there were some immediate positives that came of the situation, and he was unsure of how this experience had the potential to affect him and his children in the future.

…watching, like today Hannah making her way to university, is great. Did she have to go through this, to do it? I don’t, I don’t know if I would call it positive. Uh thank, thank God she’s in a better place. I don’t know if I would call it positive I guess I will never know until I see them as, functioning adults. I-I don’t have an answer for that. I don’t know if it at some point James’ gunna go “I-I need my mum” ‘cause I don’t know.

Hannah also expressed the same sentiment.

I think, [this experience] will make us stronger. [laughs] I think it’ll take time but, in the end I think so.

After greater reflection, almost everyone stated that they had a heightened sense of appreciation. Linda believed that she had a greater appreciation for others, and a lot of this understanding had translated into her career as well, where she was a teacher helping students.

Um, first of all it helps us appreciate p-people better. Helps us to be um, more aware of, illnesses that are around us and, what people have to go through…. I’m pretty sure that because of, everything I went through, I had a lot more compassion…I know that I-I give hugs really, at school because they know that I get it. And a lot of people come to me to talk to me about it because, I’ve been through it. Um, helps me appreciate what we have, and sometimes we forget, uh, you know we get angry about the silly things. The stuff that, really we shouldn’t be getting angry … It definitely, it definitely changes you as a person.

Hannah, having been old enough to see and comprehend what Nancy was going through, also understood how important it was to appreciate and care for others.

…I feel, more grateful for those, who I have, and I feel that [pause] if someone [pause] gets sick, that you have to be there to help them.

Linda also believed their experience made them more resilient.

It makes us appreciate more. It makes us appreciate each other more. Um, makes us realize that, we can get a lot of stuff dumped on us that um, we can still deal with.

Hannah believed that this experience, as well as her own personal struggles, facilitated her career aspirations.

I’m way more understanding now. I, I, feel now that everyone deserves as many chances as possible, ‘cause you don’t, know people’s situations. They could be having the worst time, of their life at home, and all you’re seeing is the negative, impacts, of that. Um [pause] it helped me decide what I wanted to do. Like, because, because of my mom getting sick, and me having to go to therapy I just decided that that’s kind of what I want to do. Um [pause] I don’t know, it just kind of gave me a different understanding of everything.

Dave also stated that he was more grateful for others, especially those who helped them throughout Nancy’s illness. He had never known that his family would receive so much support.

…but the situation wasn’t blessed but, to see what’s around you, i-is pretty remarkable. It does open up your heart and your mind. To see um, how how much people are willing to give, in crisis.

He also went on to say that he not only valued those who came to help Nancy, but also those who knew that he needed help too, and did so in any way that they possibly could.

The hundreds, if not thousands of dollars that were given to us for food. Um, just to make sure we were okay. The people that would visit. My friends who would call every day coming from work, “how you doing today?” You know? They couldn’t always be here ‘cause they had their families to take care of but they always found a way, to make sure, to touch base. And sometimes, and, it’s, and Nancy will understand this but, Harry called us to see how Nancy was but Harry, he didn’t call for Nancy. He called, for me, ‘cause he knew, that was his role. … There were people that, came to the house, for Nancy but then there were some people that, came, to make sure I was okay too.

It was not only friends that helped ensure he was okay, his family and coworkers did too, of which he was extremely grateful.

…you know in all honesty my, my family, my friends, [my school], great school. Um, they were there when she was diagnosed, and they were [a] godsend. They they they were, remarkable. I could only imagine the tears that, I left that place with, because when I would leave, they’re like “hey Dave” and, I know, I know when I walked out they were in tears. Because they, they cared for me completely. So it was pretty remarkable. I was in a, I was in a lot of good places, to be in a really shitty spot.

Linda also went on to say that this situation helped her appreciate not only individuals going through cancer, but those fighting different battles as well.

…you realize that in the end, I look at everything that Nancy went through and how much she fought and I look at, the emotional upheaval that it caused, it caused um, Hannah, and um, how, how much hell she went through too right? Because you know losing her mum was not an easy thing, and she had all of her emotional issues to deal with. I look at, um, you know the fact that we have mental illness all around us and we have to appreciate that. People are sick and when people are sick we have to, we have to be there for them, and we have to—we can only, be strong enough as we can, to help them. And that um, sometimes the support they need, is not just emotional, it’s, it’s also the strength that they need to know that we accept them for who they are.

The love and support that the Miller family felt while Nancy was ill made them eternally grateful for all of the support they received in their time of need.

Discussion

The Miller family had their lives completely changed while Nancy was undergoing treatment. However, throughout their journey, a journey that continues today, the family experienced silver linings.

Nancy, being the patient herself, was extremely positive and remained strong in character throughout the progression of her illness. This is consistent with work completed by Amir et al. (2012), Lauzier et al. (2005), and Duggleby et al. (2012), who found that when faced with a cancer diagnosis, the patient and in some cases, their caregivers, were focused on remaining optimistic about surviving the cancer diagnosis (Amir et al. 2012; Duggleby et al. 2012; Lauzier et al. 2005). Lewis argued that healthy spouses must remain positive for their significant others and help mediate any negative feelings they may experience (Lewis 1990). Conversely, within the context of this study, Nancy remained positive and strong for Dave, while he found it difficult to remain strong at all times. He attempted to remain strong for Nancy and their children. However, in the end it was Nancy’s strength that was unwavering until her death.

Amir et al. (2012), Duggleby et al. (2012), Helseth and Ulfsaet (2005), Lauzier et al. (2005), and James, Andershed, and Ternestedt (2007) contended that a mother’s strength when undergoing cancer treatment facilitates strength within the family (Amir et al. 2012; Duggleby et al. 2012; Helseth and Ulfsaet 2005; Lauzier et al. 2005; James et al. 2007). It also aids the family in becoming stronger individually (Amir et al. 2012; Duggleby et al. 2012; Helset and; Ulfsaet 2005; Lauzier et al. 2005; James et al. 2007). This could be seen with how well Nancy handled herself throughout the duration of her illness, and how deeply her family marveled at her strength, as well as recognized that they became stronger because of such an experience. To add, the family acknowledged that they had a greater sense of appreciation for their family members and others during this time, which coincides with the findings of Kennedy and Lloyd-Williams (2009), as well as Christ, Siegel, and Sperber (1994).

While Duggleby et al. (2012), Kennedy and Lloyd-Williams (2009), and Sheehan and Draucker (2011) stated that spouses could see positive effects of their significant other’s cancer, the opposite was true of Dave. He did not believe that his children had experienced any positive effects in going through such an ordeal, and if there were any positives that came of it, they would not be prevalent until the children were older. Hannah, who believed that this experience would make them stronger in the future, repeated this sentiment. The Millers experienced a multitude of effects when undergoing the cancer journey, making for an interesting case that has the potential for multiple implications, as well as the ability to aid other families undergoing situations similar to theirs.