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1Department of Nursing, Sahmyook Health University, 02500 Seoul, Republic of Korea
2Department of Nursing, Kangwon National University, 25949 Samcheok, Republic of Korea
*Corresponding Author(s):apnjun@kangwon.ac.kr (Byung Jun Park)
| History | Submitted: 05 June 2025 | Accepted: 20 August 2025 | Published: 15 November 2025 |
| Copyright: | ©2025 The Author(s). Published by MRE Press. |
Background: Breast cancer is one of the most prevalent cancers among women worldwide, and the physical and psychological burden of treatment significantly affects their quality of life. While medical advancements have improved survival rates, understanding patients’ subjective experiences remains critical for delivering holistic and patient-centered care. Therefore, this study aimed to explore and classify the subjective perspectives and attitudes of women with breast cancer regarding their treatment experiences using Q methodology. Methods: An exploratory Q methodological approach was used to investigate how women with breast cancer perceive their treatment experiences. The research process included: (1) generating a Q-population of 151 statements through literature reviews, open-ended questionnaires, and in-depth interviews, later refined to a 35-statement Q-sample through expert validation; (2) a P-sample of 40 participants was recruited from self-help groups in four cities between 20 April and 20 May 2025, to complete the Q-sorting procedure; (3) analyzing the data using factor analysis via the PQMethod software. Results: Four distinct typologies emerged, representing the participants’ subjective experiences: Positive Acceptance and Growth, Emotionally Unstable and Anxious, Social Relationship-Oriented, and Physically Distressed and Body-Conscious. These four types collectively accounted for 38.36% of the total variance. The intercorrelations among the types were low, suggesting relatively independent attitudinal patterns. Conclusions: The findings underscore the necessity for tailored nursing interventions and psychological support strategies that correspond to each identified type. In particular, interventions aimed at fostering emotional resilience and enhancing social support networks are critical. This study provides foundational data for developing individualized nursing and counseling programs to support women undergoing breast cancer treatment.
Cite this article
Sun Jung Park, Byung Jun Park. Subjective perceptions of breast cancer treatment experiences in women: a Q methodological approach.European Journal of Gynaecological Oncology,2025,46(11):27-37 DOI:10.22514/ejgo.2025.136
1. Introduction
1.1 Significance of research
Cancer remains the leading cause of death in South Korea, with breast cancer being the most prevalent malignancy among women and ranking fifth in overall cancer incidence nationwide [1]. Government-led screening initiatives have substantially increased access to early detection programs, leading to a marked rise in early-stage diagnoses. Concurrent improvements in treatment modalities and comprehensive patient care have contributed to a high breast cancer survival rate, currently estimated at approximately 91% [2].
The median age at diagnosis is 51.5 years, with women in their 40s and 50s accounting for the highest proportions of cases—34% and 30%, respectively—together comprising 64% of all diagnoses [3]. Standard treatment modalities for breast cancer include chemotherapy, hormone therapy, surgery, and targeted therapy. These interventions have significantly improved cure rates and long-term survival outcomes [2].
Breast cancer survivors experience vulnerabilities in physical symptoms such as fatigue, shoulder movement limitations, and bodily pain; psychological issues including depression, anxiety, and decreased sexual desire; as well as social aspects like maintaining employment and raising children [3]. These treatment-related burdens often impair survivors’ health-related quality of life [4]. Persistent issues such as fatigue, sleep disturbances, pain, and stress are common throughout the treatment process and are frequently linked to the onset of depressive symptoms [5]. Breast cancer survivors have been reported to experience more issues related to reduced reproductive function due to treatment, raising young children, severe symptoms at a young age, work-related stress, and lower body image [6].
Previous studies have identified various factors that influence the daily functioning and well-being of women with breast cancer, including sociodemographic characteristics (e.g., age, income), physical and emotional functioning, and symptoms such as pain, nausea, fatigue, depression, and anxiety [7]. While many investigations have focused on the adverse effects of breast cancer on quality of life, some have also noted the potential for positive psychological adaptation—wherein patients reinterpret their experiences in ways that promote personal growth [8].
As interest in cancer survivorship continues to grow, there is an increasing need to explore a broader range of factors affecting the quality of life in breast cancer survivors. These include not only sociodemographic and clinical variables but also lifestyle habits (e.g., smoking, alcohol consumption), health-related variables (e.g., depression, physical activity, perceived health status, and stress perception), and physiological indicators such as body mass index [9].
Beyond the general challenges of cancer treatment, women with breast cancer often face unique psychological difficulties associated with the loss of the breast—a visible and symbolically significant body part. This loss can elicit emotional responses that differ qualitatively from those experienced by individuals with other cancers. Thus, developing effective and appropriate nursing interventions requires a nuanced understanding of breast cancer treatment experiences, encompassing not only physical suffering but also psychosocial and spiritual dimensions.
In South Korea, qualitative studies on women with breast cancer have examined various themes, including the lived experience of illness [9, 10], the psychological impact of mastectomy [11], changes in sexual life [12], decision-making around reconstructive surgery [13], the lives of long-term survivors [14], and participation in self-help group activities [15]. While these studies offer valuable insights, they have primarily focused on the treatment and recovery stages following diagnosis, often overlooking the nuanced and context-specific experiences during the treatment phase itself.
Q methodology provides a robust and integrative research approach that merges the strengths of qualitative and quantitative methods. By converting subjective internal perspectives into systematically measurable external data, it allows for the objective analysis of individual subjectivity through the identification of distinct typologies [16].
This study applies Q methodology to categorize the diverse treatment experiences of women undergoing breast cancer surgery and to identify the common challenges they face. By illuminating the subjective dimensions of their treatment journey, the findings aim to lay the groundwork for individualized nursing interventions and psychosocial support strategies tailored to the needs of each identified group.
1.2 Purpose of study
The purpose of this study is to apply Q methodology to investigate the subjective perspectives and attitudes of women with breast cancer concerning their treatment experiences and to identify the defining characteristics of each resulting typology.
2. Materials and methods
2.1 Research design
This study employs Q methodology to identify the subjective perspectives—such as personal thoughts, feelings, attitudes, and opinions—of women with breast cancer regarding their treatment experiences, and to classify these into distinct typologies.
2.2 Research method
2.2.1 Q-population (concourse) development
The Q-population, which serves as the foundation for the Q-sample, can be constructed using a variety of sources, including literature reviews, individual or group in-depth interviews, open-ended questionnaires, newspaper or magazine articles, topic-related books, and media content, such as broadcasts or talk shows [17]. In this study, the Q-population was developed using methods such as a literature review, open-ended questionnaires, and individual in-depth interviews, specifically focused on breast cancer. The literature review involved the researcher and a research assistant examining breast cancer-related books and academic journals to gather information on knowledge, attitudes, and perspectives related to breast cancer treatment. Considering that the participants in this study are breast cancer patients, and that the aim is to explore their subjective experiences and attitudes toward treatment, a set of general open-ended questions was developed to reflect the diversity of their treatment experiences:
• What kind of disease is breast cancer? Please describe what you generally know about breast cancer.
• What do you think are the treatment and nursing care methods for breast cancer? Please describe what you know.
• What are the ways to prevent breast cancer? Please describe any prevention methods or activities you are aware of.
• In your opinion, what is an effective way to manage breast cancer?
To distribute the open-ended questionnaires, the researcher first explained the purpose and methodology of the study to members of a breast cancer self-help group and requested their cooperation. Ten participants voluntarily agreed to assist with the questionnaire distribution. Together with two research assistants, the researcher visited four regional self-help group meetings and asked participants to freely describe their thoughts and opinions related to breast cancer. To facilitate responses, additional participants were recruited through snowball sampling and email, resulting in a total of 20 women with breast cancer participating in the open-ended questionnaire. Although there were initial plans to form a new focus group for in-depth individual interviews, data collection continued until the responses reached the saturation point. With the participants’ consent, all interviews were audio-recorded and transcribed. Through this process, a total of 151 statements were collected for the Q-population. All participants received a small token of appreciation for their contribution.
2.2.2 Q-sample construction
Constructing the Q-sample is a critical step in Q methodology research, as it involves summarizing and condensing the breadth and depth of the Q-population. The Q-sample represents the Q-population and serves as a unit of analysis [17]. Typically, a Q-sample consists of 20 to 100 items, with 40 to 60 being the most common range [16].
For this study, a panel of four experts was formed to extract the Q-sample. The panel included the two nursing professors specializing in maternity nursing and Q methodology, and two nurses working at a women’s hospital. The panel reviewed the 151 statements drawn from the Q-population. Through three rounds of email discussions and two in-person meetings, duplicate or unclear statements were removed, and similar ones were consolidated. As a result, a final set of 35 statements was selected for the Q-sample. Statements were selected based on thematic representativeness, clarity, non-redundancy, balance of perspectives, and feasibility for participant sorting. Through this process, 35 statements were finalized for Q-sorting (Table 1).
| No. | Item |
| 1 | I experienced extreme fatigue after breast cancer treatment, which significantly affected my daily life and social activities. |
| 2 | I frequently felt discomfort due to physical changes from surgery (e.g., mastectomy, implant insertion), making certain movements or activities difficult. |
| 3 | Due to side effects of chemotherapy, I experienced a loss of appetite or difficulty eating, making nutrition management challenging. |
| 4 | Lymphedema (arm swelling) made everyday activities involving arm use (dressing, lifting objects, etc.) uncomfortable. |
| 5 | Even after treatment, physical pain from the surgical site or chemotherapy persisted. |
| 6 | To maintain health and prevent recurrence, I made significant changes to my overall lifestyle, including diet, exercise, and daily routines. |
| 7 | Weight gain or loss after treatment deepened my concerns about body image. |
| 8 | Regular exercise greatly helped with physical recovery and maintaining mental stability. |
| 9 | I experienced extreme shock and confusion upon being diagnosed with breast cancer. |
| 10 | During the treatment process, I continuously felt depression, anxiety, and lethargy, with intensified emotional ups and downs. |
| 11 | After going through breast cancer, my attitude toward life became more positive, and I came to value the present more. |
| 12 | I felt mentally stronger through the process of overcoming cancer, gaining inner strength to endure hardships. |
| 13 | Emotional instability led to conflicts in relationships with family or friends. |
| 14 | Through the cancer experience, I deeply realized the value of life and the importance of health. |
| 15 | I have a great fear of cancer recurrence and feel anxious even during routine checkups or at minor symptoms. |
| 16 | It is difficult to express my emotions honestly to those around me, and I often endure them alone. |
| 17 | I found my own ways to manage stress and regulate emotions. |
| 18 | My family’s support was a great source of strength during treatment and played an important role in my recovery. |
| 19 | My relationships with friends or coworkers changed after the breast cancer diagnosis. |
| 20 | I feel the need to connect with fellow patients who share the same experience and wish to participate in support groups or communities. |
| 21 | I have experienced discrimination or uncomfortable stares as a cancer patient in social settings. |
| 22 | Even after treatment, I face difficulties in returning to work, doing household chores, or fulfilling social roles. |
| 23 | After the breast cancer diagnosis, the reactions of people around me sometimes felt different from what I expected. |
| 24 | Excessive protection and concern from family or acquaintances can feel burdensome at times, and I want to live independently. |
| 25 | I feel uncomfortable disclosing my breast cancer experience to others and am conscious of social perception. |
| 26 | I believe my experience of overcoming cancer can give courage and hope to patients in similar situations. |
| 27 | Activities that help with mental stability, such as faith, meditation, or yoga, provided great comfort during treatment. |
| 28 | After the breast cancer diagnosis, I rethought the meaning and goals of life, experiencing major shifts in my values. |
| 29 | Due to the possibility of cancer recurrence or health concerns, making long-term plans feels burdensome. |
| 30 | Through the cancer experience, I learned to cherish my body and mind and how to love myself. |
| 31 | My values regarding life before and after the breast cancer diagnosis changed, and I redefined what is truly important in life. |
| 32 | I regained vitality and experienced positive change through new hobbies. |
| 33 | Even after treatment ended, I continued to feel mental stress and anxiety, realizing the need for psychological recovery. |
| 34 | Explanations and support from medical staff had a significant impact on treatment decisions. |
| 35 | After overcoming breast cancer, my attitude toward life became even more positive, and I feel I am living a better life than before. |
2.2.3 P-sample selection
The P-sample refers to the actual participants in the study who are asked to sort the Q-sample statements into a forced distribution, typically following a normal curve. In Q methodology, a large P-sample may result in multiple participants being assigned to the same type, which can limit the clarity of each typology. Therefore, based on small-sample theory, it is generally recommended to include around 50 participants or fewer [16]. This study was conducted between 20th April and 20th May 2025. The P-sample comprised 40 women with breast cancer who participated in self-help groups across four regions: Seoul, Incheon, Gyeonggi, and Gangwon. The participants in this study were breast cancer survivors who had completed surgery, chemotherapy, radiotherapy, and hormone therapy, and were visiting the outpatient clinic for follow-up care. The inclusion criteria were married women aged 20 years or older with a spouse, who agreed to participate in the study. Individuals were excluded if they had experienced cancer recurrence or were undergoing current treatment, had been diagnosed with and were receiving treatment for a severe psychiatric disorder, or had other acute or chronic illnesses unrelated to breast cancer, such as cardiovascular disease, respiratory disease, complicated hypertension or diabetes, or chronic renal failure.
2.2.4 Validity and reliability verification of the Q-sample
In Q methodology, validity is typically assessed through three stages: content validity, face validity, and Q-sorting validity [18]. First, content validity is generally established through a review of relevant literature. In this study, it was verified by the researcher’s review of literature and prior studies on breast cancer, as well as by confirmation from a panel of four experts who assessed the appropriateness of the 35 Q-sample statements. Second, face validity was ensured through direct meetings with the expert panel, during which the wording and content of the statements were reviewed and refined. Third, Q-sorting validity was tested using a test-retest approach. Five women with breast cancer voluntarily participated in the Q-sorting of the final 35 statements, which allowed for the validation of the statements’ consistency and clarity. Reliability in Q methodology is typically verified through a test-retest process, with a Pearson correlation coefficient of 0.80 or higher considered acceptable. Retesting is generally conducted with the same participants 1–2 weeks after the initial test [16, 19]. In this study, five women with breast cancer who expressed interest in the reliability process participated in the test phase. The clarity and appropriateness of the terminology and sentence structure were reviewed, and the same participants repeated the Q-sorting one week later. The resulting Pearson correlation coefficient exceeded 0.80, thereby confirming the reliability of the Q-sample. To verify the consistency of the instrument, the Cronbach’s alpha for the 35-item tool was calculated using participants’ responses and was found to be 0.91.
2.2.5 Q-sorting process
Q-sorting is the process of forcing the selected Q-sample statements into a predefined distribution grid. When the number of statements is 40 or fewer, it is considered appropriate to use a 9-point scale ranging from −4 to +4 [17]. On this scale, a “+” indicates agreement or a positive view of the statement, “0” represents neutrality, and a “−” signifies disagreement or a negative view. In this study, participants were first asked to read all 35 statements and sort the Q-cards into three preliminary piles: agree, neutral, and disagree. Once they had sorted the cards into these groups, they were instructed to place the cards on a 9-point forced distribution grid as follows: 2 cards each at +4 and −4, 3 cards each at +3 and −3, 4 cards each at +2 and −2, 6 cards each at +1 and −1, and 7 cards at 0 (neutral). The two cards placed at each extreme end of the scale (+4 and −4) represent the participant’s strongest agreement and disagreement, respectively. These statements provide crucial insight into each participant’s perspective and are especially valuable for interpreting and understanding the resulting types. They may also be directly quoted in the presentation of results [16, 19]. In line with this, participants were asked to provide written comments on the statements placed at the extreme ends of the distribution. The entire Q-sorting process, including this step, took approximately 30 to 50 minutes per participant.
2.3 Ethical considerations
This study was conducted after receiving approval from the Institutional Review Board (IRB) of Kangwon National University (KWNUIRB-2025-03-002-001). To ensure participants’ anonymity and autonomy, the purpose and procedures of the study were fully explained to all participants. Detailed information about the in-depth interviews, the Q-sorting process, and the test-retest procedure was provided in a written document. Participants were informed that the data collected would be used solely for research purposes, and that they could withdraw from the interviews or Q-sorting process at any time during the study if they wished to do so without any consequence.
2.4 Data analysis
For this study, data were analyzed using QUANAL (PC-QUANAL), a software package originally developed by Norman Van Tubergen in the 1960s specifically for Q methodology research. Unlike the theory-driven rotation used in PQMethod, QUANAL applies a non-theoretical, researcher-independent approach, utilizing varimax rotation to maximize explained variance [16]. Varimax rotation minimizes the loading of multiple variables on a single factor, which facilitates clearer interpretation by grouping items into distinct clusters [20]. The 35 Q-sample statements sorted on the distribution grid were first converted into scores (e.g., −4 = 1 point, −3 = 2 points, …, 0 = 5 points, …, +4 = 9 points), then coded and entered into QUANL for principal component factor analysis using varimax rotation. During the factor extraction process, factors with eigenvalues greater than 1.0 were selected, resulting in the identification of three distinct types. The factor loadings of each statement were expressed as standardized Z-scores, with scores of 1.0 or higher used as the threshold for interpretation. To better understand the characteristics of the three identified types, differences in Z-scores between factors (difference scores) and consensus items across all three types were also examined, using the same Z-score threshold of 1.0.
3. Results
3.1 Formation of the Q-types
As a result of the Q-factor analysis on the subjective perceptions of women with breast cancer regarding their treatment experiences, four distinct types were identified. These four types collectively accounted for 38.36% of the total variance. Specifically, Type 1 explained 16.80%, Type 2 accounted for 9.01%, Type 3 for 7.25%, and Type 4 for 5.30% of the variance (Table 2). The intercorrelations among the four types are presented in Table 3. The correlation coefficients ranged from r = −0.57 to 0.74, indicating low to moderate levels of association. These results suggest that, although some overlap exists, the four types are relatively independent from one another.
| Variables | Type I | Type II | Type III | Type IV |
| Eigenvalue | 6.72 | 3.61 | 2.90 | 2.12 |
| Variance (%) | 16.80 | 9.01 | 7.25 | 5.30 |
| Cumulative variance | 16.80 | 25.81 | 33.06 | 38.36 |
| Variables | Type I | Type II | Type III | Type IV |
| Type I | 1.00 | |||
| Type II | 0.69 | 1.00 | ||
| Type III | 0.74 | 0.53 | 1.00 | |
| Type IV | −0.57 | −0.40 | −0.34 | 1.00 |
3.2 Characteristics of the types
Among the participants, 10 were classified under Type 1, 16 under Type 2, 10 under Type 3, and 4 under Type 4. The demographic characteristics and factor weights of participants in each type are presented in Table 4. A higher factor weight within a type indicates that the participant strongly represents the typical characteristics of that type. To analyze the subjectivity of women’s treatment experiences by type, interpretations were based on the 35 Q-statements, with a focus on statements showing strong agreement (Z score ≥ +1) or strong disagreement (Z score ≤ −1). The distinguishing features of each type were interpreted by highlighting the statements where the Z-scores of one type showed a marked difference compared to those of the other types. Based on this analytical framework, the four identified types of treatment experiences among women with breast cancer are described below (Table 5).
| Type, Var no. | Factor weight | Age | Time Since Diagnosis | Treatment Duration | Religion | Co-morbidities | Illness Name | |
| Type I, n = 10 | ||||||||
| 5 | 0.95 | 2 | 2 | 2 | None | Yes | Diabetes | |
| 12 | 0.21 | 2 | 2 | 3 | None | Yes | Diabetes | |
| 14 | 0.46 | 2 | 2 | 2 | None | Yes | Diabetes | |
| 21 | 0.39 | 1 | 1 | 1 | Christian | Yes | Diabetes | |
| 23 | 0.44 | 1 | 1 | 2 | None | Yes | Diabetes | |
| 24 | 0.60 | 1 | 1 | 2 | Buddhist | Yes | Diabetes | |
| 27 | 0.57 | 3 | 3 | 2 | None | Yes | Hypertension | |
| 29 | 0.48 | 3 | 3 | 2 | None | Yes | Hypertension | |
| 35 | 0.36 | 2 | 2 | 3 | None | Yes | Diabetes | |
| 38 | 0.27 | 2 | 2 | 2 | None | Yes | Diabetes | |
| Type II, n = 16 | ||||||||
| 2 | 0.52 | 2 | 2 | 3 | Buddhist | Yes | Cardiovascular disease | |
| 3 | 0.47 | 2 | 2 | 3 | Buddhist | Yes | Cardiovascular disease | |
| 6 | 0.31 | 2 | 2 | 2 | None | Yes | Diabetes | |
| 7 | 1.34 | 2 | 2 | 2 | None | Yes | Diabetes | |
| 8 | 1.61 | 2 | 2 | 3 | Christian | Yes | Diabetes | |
| 11 | 0.35 | 2 | 2 | 3 | Christian | Yes | Diabetes | |
| 15 | 1.28 | 2 | 2 | 2 | None | Yes | Diabetes | |
| 16 | 1.69 | 2 | 2 | 2 | Christian | Yes | Diabetes | |
| 19 | 0.33 | 2 | 2 | 3 | None | Yes | Diabetes | |
| 20 | 0.47 | 2 | 2 | 1 | None | Yes | Diabetes | |
| 22 | 0.38 | 1 | 1 | 2 | None | Yes | Diabetes | |
| 25 | 0.25 | 3 | 3 | 2 | None | Yes | Diabetes | |
| 28 | 0.44 | 3 | 3 | 2 | Buddhist | Yes | Diabetes | |
| 34 | 0.08 | 2 | 2 | 2 | None | Yes | Diabetes | |
| 39 | 0.64 | 2 | 2 | 2 | None | Yes | Diabetes | |
| 40 | 0.38 | 3 | 3 | 2 | None | Yes | Diabetes | |
| Type III, n = 10 | ||||||||
| 1 | 1.39 | 3 | 3 | 3 | Christian | Yes | Hypertension | |
| 4 | 0.27 | 2 | 2 | 2 | Christian | Yes | Diabetes | |
| 10 | 0.29 | 2 | 2 | 3 | None | Yes | Diabetes | |
| 13 | 0.74 | 2 | 2 | 2 | None | Yes | Diabetes | |
| 18 | 0.28 | 2 | 2 | 2 | None | Yes | Diabetes | |
| 30 | 0.81 | 2 | 2 | 1 | None | Yes | Diabetes | |
| 31 | 0.41 | 2 | 2 | 2 | Christian | Yes | Hypertension | |
| 32 | 0.51 | 3 | 3 | 3 | None | Yes | Diabetes | |
| 36 | 0.49 | 2 | 2 | 2 | None | Yes | Hypertension | |
| 37 | 0.41 | 2 | 2 | 3 | Christian | Yes | Diabetes | |
| Type IV, n = 4 | ||||||||
| 9 | 1.60 | 2 | 2 | 3 | Others | Yes | Diabetes | |
| 17 | 1.40 | 2 | 2 | 2 | Christian | Yes | Diabetes | |
| 26 | 0.42 | 3 | 3 | 2 | Christian | Yes | Diabetes | |
| 33 | 0.29 | 3 | 3 | 3 | None | Yes | Hypertension |
| Type, No. | Statement | Z-score |
| Type 1, n = 10 | ||
| 28. After the breast cancer diagnosis, I rethought the meaning and goals of life, experiencing major shifts in my values. | 1.65 | |
| 2. I frequently felt discomfort due to physical changes from surgery (e.g., mastectomy, implant insertion), making certain movements or activities difficult. | 1.64 | |
| 3. Due to side effects of chemotherapy, I experienced a loss of appetite or difficulty eating, making nutrition management challenging. | 1.37 | |
| 11. After going through breast cancer, my attitude toward life became more positive, and I came to value the present more. | −1.08 | |
| 13. Emotional instability led to conflicts in relationships with family or friends. | −1.27 | |
| 12. I felt mentally stronger through the process of overcoming cancer, gaining inner strength to endure hardships. | −1.37 | |
| 14. Through the cancer experience, I deeply realized the value of life and the importance of health. | −1.61 | |
| 35. After overcoming breast cancer, my attitude toward life became even more positive, and I feel I am living a better life than before. | −3.61 | |
| Type 2, n = 16 | ||
| 21. I have experienced discrimination or uncomfortable stares as a cancer patient in social settings. | 1.66 | |
| 20. I feel the need to connect with fellow patients who share the same experience and wish to participate in support groups or communities. | 1.48 | |
| 17. I found my own ways to manage stress and regulate emotions. | 1.48 | |
| 19. My relationships with friends or coworkers changed after the breast cancer diagnosis. | 1.18 | |
| 10. During the treatment process, I continuously felt depression, anxiety, and lethargy, with intensified emotional ups and downs. | 1.12 | |
| 1. I experienced extreme fatigue after breast cancer treatment, which significantly affected my daily life and social activities. | 1.10 | |
| 13. Emotional instability led to conflicts in relationships with family or friends. | 1.06 | |
| 28. After the breast cancer diagnosis, I rethought the meaning and goals of life, experiencing major shifts in my values. | −1.12 | |
| 31. My values regarding life before and after the breast cancer diagnosis changed, and I redefined what is truly important in life. | −1.14 | |
| 32. I regained vitality and experienced positive change through new hobbies. | −1.25 | |
| 33. Even after treatment ended, I continued to feel mental stress and anxiety, realizing the need for psychological recovery. | −1.91 | |
| 35.After overcoming breast cancer, my attitude toward life became even more positive, and I feel I am living a better life than before. | −2.97 | |
| Type 3, n = 10 | ||
| 13. Emotional instability led to conflicts in relationships with family or friends. | 1.69 | |
| 16. It is difficult to express my emotions honestly to those around me, and I often endure them alone. | 1.48 | |
| 11. After going through breast cancer, my attitude toward life became more positive, and I came to value the present more. | 1.28 | |
| 15. I have a great fear of cancer recurrence and feel anxious even during routine checkups or at minor symptoms. | 1.10 | |
| 7. Weight gain or loss after treatment deepened my concerns about body image. | 1.07 | |
| 10. During the treatment process, I continuously felt depression, anxiety, and lethargy, with intensified emotional ups and downs. | 1.01 | |
| 26. I believe my experience of overcoming cancer can give courage and hope to patients in similar situations. | −1.05 | |
| 19. My relationships with friends or coworkers changed after the breast cancer diagnosis. | −1.07 | |
| 23. After the breast cancer diagnosis, the reactions of people around me sometimes felt different from what I expected. | −1.16 | |
| 22. Even after treatment, I face difficulties in returning to work, doing household chores, or fulfilling social roles. | −1.37 | |
| 20. I feel the need to connect with fellow patients who share the same experience and wish to participate in support groups or communities. | −1.38 | |
| 21. I have experienced discrimination or uncomfortable stares as a cancer patient in social settings. | −1.49 | |
| 35. After overcoming breast cancer, my attitude toward life became even more positive, and I feel I am living a better life than before. | −3.11 | |
| Type 4, n = 4 | ||
| 4. Lymphedema (arm swelling) made everyday activities involving arm use (dressing, lifting objects, etc.) uncomfortable. | 1.87 | |
| 2. I frequently felt discomfort due to physical changes from surgery (e.g., mastectomy, implant insertion), making certain movements or activities difficult. | 1.64 | |
| 12. I felt mentally stronger through the process of overcoming cancer, gaining inner strength to endure hardships. | 1.59 | |
| 18. My family’s support was a great source of strength during treatment and played an important role in my recovery. | 1.38 | |
| 15. I have a great fear of cancer recurrence and feel anxious even during routine checkups or at minor symptoms. | 1.19 | |
| 5. Even after treatment, physical pain from the surgical site or chemotherapy persisted. | −1.02 | |
| 31. My values regarding life before and after the breast cancer diagnosis changed, and I redefined what is truly important in life. | −1.04 | |
| 9. I experienced extreme shock and confusion upon being diagnosed with breast cancer. | −1.20 | |
| 25. I feel uncomfortable disclosing my breast cancer experience to others and am conscious of social perception. | −1.30 | |
| 29. Due to the possibility of cancer recurrence or health concerns, making long-term plans feels burdensome. | −1.66 | |
| 24. Excessive protection and concern from family or acquaintances can feel burdensome at times, and I want to live independently. | −1.78 | |
| 35. After overcoming breast cancer, my attitude toward life became even more positive, and I feel I am living a better life than before. | −2.37 |
According to previous research [10], when a participant shows a high factor loading (≥0.8) on a particular factor, they are considered a strong representative of that Q-type. Therefore, in this study, special attention was given to the opinions and demographic information of such participants when classifying perception types related to breast cancer treatment experiences. To determine the most optimal classification of Q-types, analyses were conducted specifying between two and five factors. The results indicated that the four-factor solution yielded the highest factor loadings across types and best represented distinct Q-types, which were ultimately adopted in the final classification (Table 5).
3.2.1 Type 1: “positive acceptance and growth”
The statements that received the strongest agreement from participants in Type 1 were “After the breast cancer diagnosis, I rethought the meaning and goals of life, experiencing major shifts in my values.” (Z = 1.65), and “I frequently felt discomfort due to physical changes from surgery (e.g., mastectomy, implant insertion), making certain movements or activities difficult.” (Z = 1.64). Conversely, the statements with which this type showed the strongest disagreement were “After going through breast cancer, my attitude toward life became more positive, and I came to value the present more.” (Z = −3.61), and “Through the cancer experience, I deeply realized the value of life and the importance of health.” (Z = −1.61). This type is characterized by individuals who interpret their breast cancer treatment as an opportunity for personal growth, while acknowledging the physical challenges of the process. They tend to emphasize the importance of support systems during treatment. Based on these characteristics, this type was labeled “Positive Acceptance and Growth”.
3.2.2 Type 2: “emotionally unstable and anxious”
The statements with which Type 2 participants showed the strongest agreement were “I have experienced discrimination or uncomfortable stares as a cancer patient in social settings.” (Z = 1.66), and “I found my own ways to manage stress and regulate emotions.” (Z = 1.48). In contrast, the statement that received the strongest disagreement was “After going through breast cancer, my attitude toward life became more positive, and I came to value the present more.” (Z = −2.97). These findings suggest that participants in this group experience high levels of psychological anxiety and emotional burden, particularly in response to physical changes following treatment. Although they attempt to find ways to manage stress and regulate emotions, they appear to struggle with emotional stability throughout the process. Therefore, this type was labeled “Emotionally Unstable and Anxious”.
3.2.3 Type 3: “social relationship-oriented”
Participants in Type 3 showed the strongest agreement with the following statements “Emotional instability led to conflicts in relationships with family or friends.” (Z = 1.69), and “It is difficult to express my emotions honestly to those around me, and I often endure them alone.” (Z = 1.48). The statement with which this type showed the strongest disagreement was “After going through breast cancer, my attitude toward life became more positive, and I came to value the present more.” (Z = −3.11). These results suggest that Type 3 participants tend to feel that their relationships with others have changed since their diagnosis. They often find it difficult to openly express their emotions, which leads to emotional isolation and interpersonal tension. This type is particularly sensitive to shifts in social dynamics and concerned about changes in their relationships. Accordingly, this type was labeled “Social Relationship-Oriented”.
3.2.4 Type 4: “physically distressed and body-conscious”
Participants in Type 4 showed the strongest agreement with the following statements of “Lymphedema (arm swelling) made everyday activities involving arm use (dressing, lifting objects, etc.) uncomfortable.” (Z = 1.87), and “I frequently feel discomfort due to physical changes caused by surgery (such as mastectomy or implant insertion), and certain movements or activities have become difficult.” (Z = 1.64). The statement that received the strongest disagreement was “After going through breast cancer, my attitude toward life became more positive, and I came to value the present more.” (Z = −2.37). These findings suggest that individuals in this group experience significant physical discomfort and anxiety related to changes in body image following treatment. They tend to focus on the limitations and inconveniences caused by their physical condition and show less optimism about life after cancer. Based on these characteristics, this type was labeled “Physically Distressed and Body-Conscious”.
4. Discussion
This study explored the treatment experiences of women with breast cancer using the Q methodology, with the aim of identifying distinct subjective perspectives and attitudes based on individual experiences. As a result, four types of perception regarding breast cancer treatment were identified: “Positive Acceptance and Growth”, “Emotionally Unstable and Anxious”, “Social Relationship-Oriented”, and “Physically Distressed and Body-Conscious”. The following section discusses the characteristics and implications of each type in greater detail.
Type 1 “Positive Acceptance and Growth” participants exhibited a tendency to reassess the meaning and goals of life following a breast cancer diagnosis, along with a noticeable shift in personal values. Despite experiencing discomfort due to physical changes, they showed an ability to accept these changes and pursue positive transformation in their lives. This reflects a characteristic inclination toward inner growth through the cancer experience. This finding aligns with the study by Menger et al. [18], which described how cancer survivors redefine their lives and aim for personal development as a result of their illness. Similarly, Darabos et al. [21] reported that the process of emotional expression and the search for new meaning among cancer patients positively influenced their health and resilience. Kim et al. [22] also found that a self-reflection program helped patients accept their cancer experience and transform it into an opportunity for growth. These findings suggest the need for psychological education programs that support meaning-making and self-reflection among breast cancer patients, helping them process their experience in a constructive and empowering way.
Type 2 “Emotionally Unstable and Anxious” participants mainly experienced emotional instability and psychological distress caused by feelings of social discrimination, uncomfortable public perception, and the overall burden of having cancer. A prominent feature of this type was the tendency to seek personal coping strategies for managing stress. This finding is consistent with the study by Hyun and Kim [23], which reported that social stigma and anxiety among cancer patients can hinder psychological recovery. Similarly, Wang et al. [24] emphasized the need for cancer patients to learn emotional expression and regulation techniques to reduce anxiety in their daily lives. Their research also showed that stress management training and emotional expression programs were effective in alleviating anxiety. Based on these findings, it is essential to develop and implement counseling programs and stress management techniques tailored to support the emotional stability of women with breast cancer.
Participants in Type 3, “Social Relationship-Oriented” were characterized by heightened emotional fluctuations and frequent conflict in relationships with family or friends. They also reported difficulty in expressing their emotions openly, often choosing to endure their feelings in isolation. This finding is consistent with the study by Çakir et al. [25], which highlighted that cancer patients may experience psychological isolation due to changes in their social relationships. Ruiz-Rodríguez et al. [26] also emphasized that accepting relational changes and improving communication with others are critical factors in promoting emotional stability. They found that social support and communication skills training had a positive impact on patients’ psychological well-being. These results suggest a need for programs that support patient-family communication and strengthen social support systems. Providing education programs for family members and friends is also important. Additionally, peer support groups for breast cancer patients who feel socially isolated after treatment could serve as an effective source of emotional and relational support.
Type 4, “Physically Distressed and Body-Conscious” participants were primarily characterized by discomfort resulting from physical changes and a persistent fear of cancer recurrence. In particular, they reported significant inconvenience caused by lymphedema and ongoing anxiety about the possibility of relapse. This finding aligns with the study by Sebri et al. [27], which found that cancer survivors often experience continued anxiety due to changes in body image and concerns about recurrence. The same study also reported that programs aimed at helping patients rebuild confidence can be effective in improving negative perceptions of body image and restoring self-esteem. Therefore, it is necessary to provide physical rehabilitation programs that address physical discomfort, as well as regular psychological counseling sessions to support breast cancer patients in coping with body image concerns and the emotional distress associated with recurrence anxiety.
A common thread across the four identified types in this study is the coexistence of both positive transformation and negative experiences following a breast cancer diagnosis. Participants experienced psychological conflict as well as a process of acceptance across various dimensions, including physical changes, social relationships, and emotional shifts. This finding is consistent with the work of Almeida et al. [28], who emphasized the importance of cancer patients redefining the meaning of life and embracing their experiences in a constructive way. Furthermore, studies have shown that integrative acceptance of one’s cancer journey significantly contributes to psychological recovery and rehabilitation [28, 29]. These findings highlight the need for healthcare professionals to actively listen to patients’ emotions and engage in open communication, thereby encouraging more active participation in the treatment decision-making process. It is also essential to develop and implement tailored interventions that reflect the characteristics of each type—such as personalized psychological support, social relationship restoration programs, and physical rehabilitation initiatives. The results of this study contribute to a deeper understanding of breast cancer treatment experiences and can serve as foundational data for designing personalized nursing care and psychosocial support programs for women with breast cancer.
That said, this study has its limitations. It focused exclusively on a specific group—married female breast cancer survivors in follow-up care—so caution is warranted when applying the results to other populations, such as younger women, unmarried individuals, or those still undergoing active treatment. Moreover, while the typologies identified here provide a useful framework, the effectiveness of customized programs built on these types has yet to be tested in practice. This study targeted breast cancer survivors who had completed treatment, which limits the generalizability of the findings. Since treatment experiences may differ depending on the time elapsed since completion, future studies are recommended to explore treatment experiences by categorizing survivors based on the duration of their post-treatment period [30]. In addition, this study identified treatment status without distinguishing between specific types or methods of treatment, which may have had varying impacts on patients’ experiences. Lastly, as the study focused solely on female breast cancer survivors, future research should include family members to explore variables related to their experiences and examine potential differences.
5. Conclusions
This study used a Q methodology to examine how women with breast cancer perceive and make sense of their treatment experiences. Through this approach, we identified four distinct perception types: Positive Acceptance and Growth, Emotionally Unstable and Anxious, Social Relationship-Oriented, and Physically Distressed and Body-Conscious. These classifications reflect the diverse ways in which individuals process the physical and emotional impacts of breast cancer, offering practical guidance for developing more personalized and responsive care strategies. Our findings highlight the need to move beyond a one-size-fits-all approach to survivorship care. Each identified type points to specific areas of psychological and social vulnerability—whether it be fear of recurrence, isolation in relationships, or challenges related to body image and physical discomfort. Interventions that address these needs with sensitivity and precision can play a key role in helping survivors recover not just physically, but emotionally and socially as well.
Availability of data and materials
The datasets supporting the conclusions of this article are available within the manuscript. No additional data are available.
Author contributions
SJP—Conceptualization or/and Methodology; Data curation or/and Analysis; Project administration or/and Supervision. BJP—Funding acquisition; Investigation; Resources or/and Software; Validation and Visualization; Writing original draft or/and Review & editing.
Ethics approval and consent to participate
This study was conducted after receiving approval from the Institutional Review Board (IRB) of Kangwon National University (KWNUIRB-2025-03-002-001). With the participants’ consent, all interviews were audio-recorded and transcribed.
Acknowledgment
Not applicable.
Funding
This research received no external funding.
Conflict of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.
