Disclosure, social support, and meaning-based coping among Omani mothers living with breast cancer: a phenomenological qualitative study

Abstract

Purpose

Mothers diagnosed with breast cancer in collectivist, faith-oriented societies face dilemmas regarding the timing, manner, and extent of disclosure of their illness to their children and extended family members. However, evidence addressing this issue within Arab contexts remains limited. This phenomenological qualitative study explored how Omani mothers with breast cancer navigate disclosure, interpret familial and communal responses, and employ coping strategies within sociocultural and religious frameworks.

Methods

In-depth semistructured interviews were conducted in Arabic with 18 Omani mothers diagnosed with stage I–III breast cancer, parenting at least one child aged 6–18 years. Participants were recruited from a national cancer care center in Muscat. The interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed using the framework method, supported by NVivo.

Results

Three themes emerged: (1) illness disclosure and communication strategies; (2) family and community responses to the diagnosis; and (3) coping strategies grounded in faith, patience, and behavioral adjustment. Women’s experiences were shaped by maternal roles, anticipated stigma, and faith-informed interpretations of illness. Disclosure decisions influenced the mobilization of support within kinship networks. Furthermore, coping mechanisms integrated religious meaning-making with efforts to maintain normalcy.

Conclusion

These findings underscore the need for culturally responsive, family-centered psychosocial care in cancer services.

Introduction

When a mother is diagnosed with cancer, the act of disclosure transforms into a complex task that involves communication, relationship dynamics, and moral considerations. Parents frequently express the difficulty of balancing various responsibilities: shielding their children from emotional distress, upholding family routines, and maintaining trust, all while facing the uncertainties and challenges of treatment. Research on parents with cancer consistently demonstrates that disclosure is not a one-time event; rather, it evolves over time through a series of staged conversations, selective sharing of information, and continual adjustments based on children’s inquiries and the observable impacts of illness and treatment [1–4]. In the context of breast cancer, the challenges faced by mothers are often exacerbated due to the disease and its treatment, which can significantly disrupt daily parenting in highly visible ways (e.g., fatigue, pain, changes in appearance, and frequent clinic visits). These visible changes may make it difficult for the mothers who delay or limit disclosure to keep the illness hidden from the children [3]. A qualitative synthesis examining the experiences of mothers with breast cancer reveals that strategies for disclosure are influenced by several factors, including the perceived maturity of the child, concerns regarding potential psychological harm, uncertainty surrounding prognosis, and the emotional preparedness of the mothers themselves [3]. Communication strategies may vary widely, encompassing a spectrum from partial disclosure to open and repeated discussions, tailored with age-appropriate language [3].

Illness disclosure is intertwined with the broader family and social environment, where communication is a collective negotiation rather than an individual decision [5, 6]. Family members can influence what information is shared, when it is shared, and with whom [5, 6]. They may promote openness to mobilize support and sometimes encourage secrecy to prevent worry, stigma, or social consequences [6, 7]. In collectivist and family-centered settings, practices surrounding disclosure and communication are often shaped by shared norms regarding privacy, emotional restraint, and the protection of family reputation, impacting interactions that extend beyond the household to the wider community [5]. Following the disclosure of a diagnosis, significant changes may occur in the responses of family and community from practical and emotional support to withdrawal, overprotection, or stigmatization. Qualitative research conducted among Omani women diagnosed with breast cancer elucidates how such a diagnosis can alter social interaction patterns and the dynamics of relationships with family and community during treatment [8]. In this study interactions with children centered on maintaining normalcy, spouses commonly provided emotional support, and family and friends were important sources of assistance, although concerns about stigma led some women to conceal their diagnosis. Evidence from broader Arab settings similarly indicates that women’s roles as mothers, wives, daughters, and family care providers influence how breast cancer and familial support are experienced [9]. This underscores the notion that the surrounding response environment is not consistently supportive and is influenced by cultural expectations and the social meanings associated with cancer [5]. Evidence from Arab settings indicates that women’s roles as mothers, wives, and daughters commonly position them as family care providers. A breast cancer diagnosis can disrupt these established roles by requiring women to receive care while they continue to feel responsible for protecting their families’ emotional and practical well-being [9]. In broader Arab contexts, cancer-related stigma is increasingly acknowledged as a phenomenon that can significantly impact psychosocial well-being and influence the extent to which women feel comfortable discussing the illness within their social networks [8].

Coping strategies emerge within the context of disclosure and response rather than in isolation. Parental coping mechanisms may encompass meaning-making, spiritual or religious framing, emotion regulation, and strategic communication, all aimed at preserving maternal identity and enhancing family functioning. Evidence from Oman suggests that women frequently rely on cultural, religious, and spiritual beliefs as primary coping resources following a breast cancer diagnosis [10]. This indicates that coping strategies may exhibit contextual patterns and are intricately associated with disclosure choices as well as the anticipated or received responses from others [3]. Despite the increasing body of research in psychosocial oncology, significant gaps persist in understanding how mothers diagnosed with breast cancer navigate disclosure and communication strategies. Furthermore, the influence of familial and community responses on these decisions, as well as the construction of coping mechanisms within specific sociocultural contexts, remains inadequately understood. The existing synthesis of literature consistently advocates for more in-depth, culturally contextualized examinations of the processes of disclosure, as well as the interplay between communication, social responses, and coping throughout the illness trajectory [3]. This study examined disclosure decision-making and communication practices among Omani mothers living with breast cancer, as well as how family and community responses shaped their experiences of social support. It also explored the meaning-based coping strategies employed by mothers to manage the psychological and social challenges of living with breast cancer within their sociocultural context.

Materials and methods

Study design

A phenomenological qualitative design was selected for its ability to illuminate complex, deeply personal experiences. Phenomenology seeks to distill the essence of participants’ perceptions, emotions, and interpretations [11]. This approach enables a nuanced understanding of how Omani women make sense of their diagnosis, treatment journey, source of support, and coping strategies. Data were generated through individual, in-depth interviews, a flexible technique well suited to eliciting rich, context-sensitive narratives [12]. By focusing on participants’ own language, the analysis remained anchored in their perspectives.

Study participants and selection

The present study was conducted at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), University Medical City, Muscat, Oman. As the nation’s principal tertiary oncology facility, the SQCCCRC offers comprehensive multidisciplinary care, advanced diagnostic and therapeutic services, and a dedicated psycho-oncology department. A purposive sampling strategy was applied to recruit eligible participants according to clearly defined inclusion and exclusion criteria. The first inclusion criterion was Omani nationality, which was essential for maintaining cultural and linguistic homogeneity, particularly in how psychological and physical concerns were perceived and reported. The second criterion was age between 18 and 60 years. This age range was selected to include adult women who were capable of providing informed consent. Women under 18 years of age were excluded due to legal and ethical considerations regarding consent and vulnerability. The third inclusion criterion was a diagnosis of stage I–III breast cancer, as such patients are typically undergoing active, curative treatment. The fourth inclusion criterion was having children aged 6–18 years. Mothers were included if they had at least one child between the ages of 6 and 18 years. However, the following patients were excluded from the study: women diagnosed with stage IV breast cancer, patients with cognitive impairments, and patients with significant psychiatric disorders. Women with stage IV breast cancer were excluded due to the distinct clinical and psychosocial profiles associated with advanced, metastatic disease.

Data collection procedure

Semistructured interviews constituted the principal data-gathering method, which enabled an in-depth exploration of the lived experiences of Omani women with breast cancer. The semistructured interview guide was specifically designed for this research to investigate the lived experiences of Omani mothers regarding breast cancer diagnosis, disclosure, and parenting young children. The guide was shaped by a comprehensive review of the literature on parental cancer, illness disclosure to children, psychosocial impacts, coping mechanisms, and cultural influences, with particular attention to studies conducted in Middle Eastern and collectivist contexts and was developed to align with the study objectives.

This format balances structure, through a predesigned guide, with flexibility, allowing the interviewer to probe emergent themes and helping participants articulate nuanced emotions and perceptions [13]. The interview guide comprised open-ended questions inviting women to recount their diagnostic journeys, treatment experiences and coping strategies in their own words, thereby yielding rich, context-specific narratives. All interviews were conducted in Arabic, in private hospital rooms within the SQCCCRC to maximize confidentiality and comfort. With participants’ written consent, each session was audio-recorded and later transcribed verbatim for framework analysis. The researcher adopted a participant-led approach, following each woman’s narrative trajectory and allowing her to elaborate on issues she deemed salient; this rapport-building strategy proved especially valuable when discussing sensitive topics. Of the 26 eligible women approached, 18 agreed to participate; eight declined owing to emotional discomfort, time constraints, or reluctance to discuss their experience. Recruitment ceased once data saturation was reached [14], as no new themes emerged. Interview durations ranged from approximately 17 min to 1 h and 33 min, with an average duration of around 42 min. The duration of each interview depended on the extent to which the individual participant chose to elaborate on the experience.

Data analysis

All 18 interviews were conducted in Arabic and were audio-recorded by the researcher. The recordings were transcribed verbatim in Arabic and subsequently translated into English by a professional translator experienced in qualitative research translation. To ensure both linguistic and conceptual fidelity, two researchers independently reviewed each transcript, cross-checking translations for consistency and clarity of key terms and expressions. The qualitative analysis was conducted using the English language transcripts. Analysis followed a two-stage framework approach [15]: familiarization, identification of a thematic framework, indexing, charting, and mapping and interpretation. First, the most information-dense transcript was analyzed to establish an initial thematic framework, identifying key patterns and categories. This framework guided the systematic coding of subsequent transcripts, with interactive refinements as new codes and subthemes emerged. NVivo 14 software (Lumivero, New York, USA) facilitated data management, systematic coding, and auditability of analytic decisions [16]. Regular discussions with the supervisory team supported reflexive interpretation and consensus-building around final themes and subthemes.

Ethical consideration

This study was conducted in accordance with the Declaration of Helsinki, and approval was received from the Medical Research Ethics Committee of the SQCCCRC (Project ID CCCRC-20–2022). All participants provided written informed consent after receiving detailed information about the study’s aims, procedures, potential risks, and benefits. Confidentiality was safeguarded by assigning each interview transcript a unique identifier and storing audio files, consent forms, and reflective journals in a secure, access-controlled environment. Participants were informed of their right to withdraw at any time without any consequences for their clinical care.

Results

Participant characteristics

The 18 participants were aged between 33 and 55 years (mean = 44.33 ± 6.36 years). Most were married (n = 15, 83.3%), while three (16.7%) were divorced. Educational attainment varied: nine held diplomas, seven possessed bachelor’s degrees, and one completed a master’s and another a doctoral degree. Two-thirds of the sample (n = 12, 66.7%) were unemployed or retired at the time of data collection, with the remainder employed (n = 6, 33.3%). Nine women (50.0%) reported a family history of cancer. Regarding clinical staging, the majority of women were diagnosed at stage II (n = 11, 61.1%), six (33.3%) were at stage III, and one participant (5.6%) presented with stage I disease. Geographically, participants were evenly divided between those residing in the capital region and those living outside it. Family sizes ranged from one to six children (Table 1).

Table 1.

Demographic and clinical characteristics of the interviewed women with BC (n = 18)

Participant	Age	Marital status	Education	Employment	Number of children	Family history of cancer	Disease stage	Residence
SQUCCCRC1	45	Married	Bachelor	Unemployed	5	No	II	AlBatinah South
SQUCCCRC2	40	Divorced	Diploma	Unemployed	2	No	III	Dhofar
SQUCCCRC3	55	Married	Bachelor	Unemployed	2	Yes	II	Muscat
SQUCCCRC4	52	Married	Diploma	Unemployed	5	Yes	II	Muscat
SQUCCCRC5	42	Married	Bachelor	Employed	3	Yes	II	AlBatinah North
SQUCCCRC6	45	Married	Diploma	Employed	4	No	II	Muscat
SQUCCCRC7	44	Married	Diploma	Unemployed	2	No	II	A’Dhahirah
SQUCCCRC8	36	Married	Diploma	Unemployed	3	No	II	AlBatinah North
SQUCCCRC9	33	Married	Diploma	Unemployed	3	Yes	III	Muscat
SQUCCCRC10	45	Divorced	PhD	Employed	1	Yes	II	Muscat
SQUCCCRC11	54	Married	Diploma	Unemployed	3	No	I	Muscat
SQUCCCRC12	39	Married	Bachelor	Employed	3	No	III	Muscat
SQUCCCRC13	43	Married	Bachelor	Employed	2	Yes	II	Muscat
SQUCCCRC14	53	Married	Diploma	Unemployed	6	No	III	AlBatinah North
SQUCCCRC15	47	Married	Bachelor	Unemployed	3	Yes	II	Muscat
SQUCCCRC16	37	Married	Bachelor	Employed	2	Yes	III	AlBatinah North
SQUCCCRC17	40	Married	Diploma	Unemployed	5	No	III	A’Dakhiliya
SQUCCCRC18	48	Divorced	Bachelor	Unemployed	4	Yes	II	AlBatinah North

Overview of themes and subthemes

Inductive framework analysis of the 18 in-depth interviews yielded three principal themes, each comprising multiple interrelated subthemes. These themes encapsulate the multifaceted and deeply personal experiences of Omani women navigating breast cancer from diagnosis through communication and psychological adaptation. The three themes are [1] disease disclosure and communication, [2] support systems in response to disclosure, and [3] coping strategies. A concise summary of themes and subthemes is provided in Table 2.

Table 2.

Main themes and subthemes emerging from interviews with women diagnosed with breast cancer (n = 18)

Main theme	Subtheme
Theme 1: disease disclosure: communication strategies and emotional impact	1. Factors influencing disclosure   - Reasons for choosing to disclose   - Reasons for choosing not to disclose   - Reasons for choosing to disclose selectively 2. Communication strategies   - Communication strategies with dhildren   - Communication strategies with relatives 3. Nondisclosure   - Decision of nondisclosure   - Strategies for maintaining secrecy 4. Emotional and psychological effects of disclosure and nondisclosure   Emotional effects of disclosure   Emotional effects of nondisclosure
Theme 2: support systems in response to disclosure	1. Emotional support 2. Practical or physical support
Theme 3: coping strategies	1. Psychological/spiritual coping 2. Behavioral coping 3. Lifestyle coping

Theme 1: disease disclosure: communication strategies and emotional impact

This theme examines the complex and deeply personal decisions involved in revealing a breast cancer diagnosis. Participants navigated whether, when, and how to share their condition based on emotional, cultural, relational, and situational factors. The theme is organized into four subsections: [1] factors influencing disclosure, which outlines reasons for open, selective, or nondisclosure; [2] communication strategies, focusing on methods used with children and relatives; [3] nondisclosure, detailing tactics of concealing the diagnosis and maintaining privacy; and [4] emotional and psychological effects of disclosure and nondisclosure, reflecting on the personal consequences of these choices.

Subtheme 1: factors influencing disclosure

Participants’ decisions about disclosure fell into three broad patterns, open, selective, or withheld, each guided by specific motivations, and these motivations often differed depending on whether disclosure was directed to adults or to children. Many women described openness to adults as a means of securing emotional and practical support. They felt that informing trusted members of their social network was necessary to secure encouragement, assistance, and understanding from their social network. One participant explained, “Because you need support and assistance, how will you get this if you hide it? This illness especially needs someone to talk to you, someone to encourage you, someone to push you forward. So, you won’t get this unless you speak up and let them know” (P1).

In contrast, when disclosure involved children, women’s reasoning was more explicitly tied to children’s age, developmental readiness, and the anticipated demands of treatment. Some participants highlighted the importance of preparing younger family members for emergencies or treatment-related challenges. They felt that children who were old enough to understand could respond appropriately when needed. For example, one participant noted, “I didn’t want them to know because they were young, but then I realized that it was much better that they knew because they will be able to know how to react in certain circumstances when an action needs to be taken” (P2). Similarly, another participant emphasized that her daughter was at an age where she could understand and handle the information, which motivated her to share the news rather than keep it from her.

Conversely, some women withheld their diagnosis due to fears of causing psychological distress, particularly to elderly or emotionally sensitive relatives. This protective instinct often led them to share only partial information or to conceal the nature of their illness altogether. One participant mentioned, “Regarding my mother, I only told her I was undergoing a surgical operation, but I didn’t share with her that it was because I had breast cancer. My mom is the type of person who is easily distressed by any bad news” (P3). Similar protective motivations were also described in relation to children, where nondisclosure was framed as shielding them from worry and fear. One participant explained that she refrained from sharing her diagnosis with her children, expressing a desire to shield them from psychological distress: “We also didn’t tell my daughters about my diagnosis. Mainly, I didn’t want them to be stressed or afraid of their mother. I didn’t want them to overthink what would happen to me” (P11).

Selective disclosure also emerged when participants weighed practical considerations, family dynamics, and cultural norms in deciding whom to inform. Some women confined their news to those geographically or emotionally closest, aiming to maintain control over how the information spread. Others judged certain relatives as better equipped to handle the news, while sparing more vulnerable family members from anxiety or embarrassment. One participant shared, “I didn’t have the intention to tell anyone, but both my parents were in India, and I called to tell them about the diagnosis after knowing it; my mother told her sisters about it, which made everyone know about it” (P2). Another reflected on how cultural sensitivities and gender norms affected her decision to be selective in her disclosure, expressing concern about the embarrassment associated with discussing a breast cancer diagnosis openly: “I didn’t want my news to become widespread. I mean, how do I even go about saying the word ‘breast’ in front of my male relatives? I thought that, due to our cultural norms, it’d have been too embarrassing” (P13). One more participant described how selective disclosure was guided by the perceived emotional resilience of different family members, explaining that her son seemed more sensitive and less aware of his surroundings compared to her daughter: “I feel like my son is more sensitive than my daughter and less aware of his surroundings than hers. If I hadn’t told him, I felt like he wouldn’t have noticed anything else going on” (P7).

Subtheme 2: communication strategies

This subtheme examines the various approaches adopted by participants who chose to disclose their diagnosis to children and family members. Participants adapted the amount and form of information according to each child’s age and ability to understand. Balancing honesty with protection meant providing children with sufficient information to understand the diagnosis and treatment while simplifying or withholding details that may cause fear or distress. “I didn’t have a direct conversation with my children about my diagnosis. They saw my medication bags, and I felt they understood without me needing to explain everything” (P1). Others enlisted trusted family members to translate complex information into child-friendly narratives, using stories or play to convey the situation without overwhelming the child. “It is not only restricted to the doctors, but it might also be a family member, for example, who can do it in a good way: it might be a story or a game that they can understand the situation from” (P2).

Prior exposure to medical terminology, learned through older relatives’ illnesses, sometimes reduced the need for detailed explanations. “It might be dependent on the children’s age and the child’s level of education. For example, my daughter already went through some experiences before my diagnosis with my mom. When my mom got sick, my daughter inadvertently got exposed to some medical terms like ‘cancer,’ chemotherapy,’ and ‘radiation.’ Even if I was talking to someone on the phone and I would say: ‘I just came back from a radiotherapy session,’ my daughter already knew what that phrase meant” (P10).

Several participants opted for full transparency, valuing straightforward communication rather than withholding information to protect their children. Those who chose to be direct and transparent in sharing their diagnosis with their children often highlighted the children’s age, maturity, and ability to understand the situation as key factors. “We told my children about my diagnosis. We’re people who don’t like to lie or beat around the bush. We told them outright about it” (P3).

In many cases, participants also disclosed their diagnosis to relatives in response to urgent practical needs, such as arranging family support for treatments or fulfilling hospital requirements. These disclosures were often prompted by immediate logistical concerns and were carefully timed to ensure the necessary assistance could be mobilized. “The nurse who called me from the hospital also informed me that I needed to have family members, preferably my siblings, donate some blood for my operation. So, I wrote in our family WhatsApp group that whoever is in Muscat and can donate some blood should because I have been diagnosed with breast cancer. I must have caused them quite a shock, dropping the news on them so suddenly” (P10). Others chose distinct methods, such as voice notes or text messages, to soften the emotional intensity of face-to-face conversation when they felt too overwhelmed to speak directly. One woman explained that she was too emotional to speak directly and felt overwhelmed while recording the message: “I didn’t tell them the news face to face. I instead sent it in a voice note. I remember that I was crying while sending the voice note” (P17).

Subtheme 3: nondisclosure

This subtheme highlights the ways participants managed to conceal their diagnosis from close family members, such as children, parents or siblings, primarily to protect them from emotional distress and maintain a sense of normalcy. Strategies included providing alternative explanations, hiding visible treatment cues, and enlisting trusted relatives to control information flow. These efforts reflected cultural expectations to shield loved ones from worry as well as a desire to avoid additional emotional burdens within the family. These choices were frequently shaped by social pressures that made open disclosure difficult, as well as the need to balance honesty with emotional protection. “I change the bags. I didn’t bring them home. I put them in bags from the university hospital because I’m already being treated at the university hospital. I put them there, and even the box of hormonal medication, I don’t take it out. I only take out the strips” (P5).

Several narratives involved fabricating stories about their health or travel, either to delay disclosure or to explain away signs of treatment. A participant chose to withhold the diagnosis from her mother by framing her medical visit as routine and nonserious. By labeling it as “just a normal infection,” she minimized the concern it might provoke, suggesting that the decision to lie was rooted in a desire to protect her mother emotionally: “When my mom asked me what happened at the doctor, I told her that I was alright and that I was told it was just a normal infection” (P14).

Subtheme 4: emotional and psychological effects of disclosure and nondisclosure

This subtheme examines the emotional repercussions of choosing whether, or when, to share a cancer diagnosis with family. Decisions around disclosure or concealment were driven by a desire to protect loved ones (especially children), yet both strategies imposed a significant psychological burden. Participants described being cautious in daily interactions to prevent unintended revelations and reported intense, sometimes overwhelming reactions when the truth finally emerged. Both disclosure and nondisclosure carried emotional weight, shaped by timing, method of communication, and family dynamics.

Revealing the diagnosis to the family of one woman led to visible emotional distress, such as crying and sadness, which transformed a private struggle into a shared family crisis. She explained that this made the experience feel more difficult. “Seeing my family in distress, their tears, their sadness, it made everything feel heavier. It wasn’t just my diagnosis; it affected all of us” (P1). Some participants struggled internally with guilt and anguish for involving their children in such pain. One mother shared the torment of wanting her children to remain happy and carefree: “Honestly, I feel a burning sensation, you know. I didn’t want my children in this situation, with sadness and all. I wanted them to live their lives, but I mean, I just didn’t want my children to be in a sad situation; I wanted their whole lives to be happy” (P4).

Conversely, withholding the diagnosis also carried a heavy burden tied to secrecy. One participant described how secrecy caused anxiety over potential discovery, and delayed disclosure could provoke feelings of betrayal. When the daughter was later informed, she showed visible distress and anger that was rooted in feeling humiliated and excluded. Another participant recalled her son’s frantic reaction when the neighbors, rather than his family, revealed the diagnosis. He responded with crying, shouting, and a sense of betrayal: “My son found out about my diagnosis from my neighbors. He heard them talking about my condition ……I think he was very shocked. He cried a lot. I remember he stayed a long time in his room alone, crying his eyes out….. He hysterically asked her why no one had told him that his mom was sick” (P7). One participant explained that hiding her diagnosis from her children created ongoing emotional tension. During family gatherings and phone calls, she felt physically tense and mentally pressured, fearful that someone might accidentally reveal her secret or notice signs of the illness. For some families, the fallout extended beyond immediate distress, manifesting in children’s behavior and daily routines. One mother reported that her daughter refused to attend school, terrified that her mother might die in her absence and that she would miss the chance to say goodbye, etching trauma from her grandmother’s death: “After she found out about my diagnosis, she got very scared. I remember that one time, her school called me and informed me that my daughter said she didn’t want to come to school anymore. She said that because she was afraid that while she was at school, her mom would pass away”(P10).

Theme 2: support systems in response to disclosure

Participants who chose to disclose their cancer diagnosis described a wide array of support systems that were mobilized once their condition became known. These networks provide essential emotional and practical support, helping women navigate the challenges of treatment and recovery. This theme comprises two subthemes: [1] emotional support, detailing the encouragement and presence offered by family, peers, and the broader community, and [2] practical or physical support, encompassing tangible assistance with daily tasks and healthcare logistics.

Subtheme 1: emotional support

This subtheme focuses on the emotional care participants received from family members, spouses, siblings, children, and close friends following disclosure, highlighting how reassurance, nonjudgmental presence, and small gestures of kindness eased their psychological burden. One participant explained that encouragement from close relatives played a crucial role in sustaining her resilience: “This is what I tell you: this illness requires patience, endurance, and support from the entire family. If you don’t get support and encouragement, you won’t be able to overcome it. It’s the stance of the family and the stance of people close to you that makes everything easier. Alhamdulillah for everything” (P1). Others emphasized the consistent support they received from spouses and siblings, describing them as emotional anchors that provide reassurance and protect against additional psychological burden. One participant shared that her husband’s silent acceptance normalized the woman’s experience by refusing to dwell on her physical changes: “He was very supportive; he supported me and the girls, never heard anything from him about the changes that happened to my body, and never pointed to my feminine identity. He was with me on most of my appointments, but sometimes, he didn’t come because of his work commitments. He is very supportive; he never mentioned that something in my body had changed, or I was incomplete from a masculine perspective, and he supported me a lot” (P2).

Support was not limited to spouses; older children and broader social ties also provided vital emotional support and practical assistance. Several participants described how their daughters accompanied them to medical appointments, offering companionship and reassurance during critical moments. “I remember during that time, my daughter was in her 2nd year of college, and she was with me during the whole operation process” (P3). Social support beyond the immediate family, many participants drew strength from their broader social networks. Neighbors, extended family, and friends reinforced a sense of belonging and reduced isolation. One woman described her aunt’s role in sharing similar experiences and prayers for her recovery: “My aunt, for example, keeps telling me about the experiences of people she knows, also from the circle of my mother; they keep telling her about their daughters and relatives who went through the same thing. Sometimes, I hear people pray for me and my daughters, and this makes me happy” (P2). Others appreciated regular check-ins from friends, neighbors, and the wider community, which served as a continual reminder that they were not facing the journey alone: “My family and friends are all around me, giving me amazing support. Even my neighbors have supported me throughout this journey” (P11).

Subtheme 2: assistance with daily tasks

In addition to emotional support, participants emphasized the critical role of practical help in lightening their daily burdens during treatment. Family members, extended relatives, and domestic helpers stepped in to manage household chores, childcare, and schooling responsibilities, which allowed participants to prioritize medical appointments and rest without compromising family routines. One participant described how living adjacent to supportive relatives, and her daughter’s involvement, ensured that household tasks and sibling care were never neglected: “We received a lot of help. Our house and my aunt’s house are close, with just a wall separating them. My aunt, my mother-in-law, may Allah bless her, was like a second mother to me and my children. So, I never felt alone, and she was always there for us. My daughter was in the eleventh grade, and she could take care of her siblings” (P5). Several women described relatives handling educational support when they were too ill to assist their children with schoolwork. One mother explained how her brother-in-law’s wife took over tutoring her son, even prompting a school transfer for proximity: “Before my disease, I used to help my son with his studies from when he was in 1 st grade till the 3rd grade. After I got ill, the wife of my brother-in-law took over from me and started helping him with his studies. We even transferred his schools so he could be closer to them” (P8). Engaging paid help also provided relief from daily household chores. Some participants hired full-time maids to handle chores such as laundry, cleaning, and cooking, later adjusting support levels as their health improved: “I got myself a maid to help with household chores. Now, I’m feeling way better, so I’ve stopped the maid from coming. Whenever I need anything done nowadays, I just get a part-timer” (P10). Others relied entirely on family to manage the majority of household responsibilities. One woman noted that her husband and children took on the bulk of daily tasks, supplemented by domestic assistance, which further eased the burden and allowed her to focus on recovery: “My husband and kids took care of almost everything. Thankfully, a maid was also at home to help with everyday chores” (P15).

Theme 3: coping strategies

This theme explores the diverse strategies participants adopted to navigate the challenges posed by their illness and its impact on daily life. Women drew on psychological and spiritual resources, engaged in purposeful activities to maintain a sense of agency, and adapted their lifestyle choices to preserve social connections and normalcy. This theme comprises three interrelated subthemes: [1] psychological/spiritual coping, [2] behavioral coping, and [3] lifestyle coping.

Subtheme 1: psychological and spiritual coping

Many participants frequently cited their faith as a primary source of strength and acceptance when confronting uncertainty. Framing breast cancer as a test from Allah allowed many to relinquish attempts to control outcomes and instead cultivate patience, prayer, and trust in Allah’s divine plan. This spiritual orientation, deeply rooted in Islamic values of endurance and submission, offered both comfort and meaning amid hardship: “I told him this is from Allah, and one should rely on Allah, and Insha’Allah, things will be fine” (P1). Several women emphasized that patience itself became a key to hope, highlighting their affliction as part of Allah’s plan rather than a challenge to be overcome solely by human effort: “I always say that this is an affliction from Allah, and we need to have patience because it is the key to hope” (P2). The idea of divine destiny underpinned many coping narratives, acceptance of what Allah has decreed enabled participants to persevere without undue anxiety: “I believe that whatever happens to me is designated by Allah, the Almighty. What’s meant to happen to us will happen to us no matter what. We just need to accept our destiny and our situation and persevere through it” (P6).

Subtheme 2: behavioral coping

This subtheme highlights the concrete actions participants adopted to manage emotional distress and reclaim a sense of control amid illness. Many women immersed themselves in familiar routines (e.g., household chores, farming, exercise) or returned to academic and professional commitments to preserve normalcy. Others proactively educated themselves about their condition, performed regular self-examinations, and made practical decisions to confront or accommodate changes in their physical appearance. These structured activities offered distraction, emotional relief, and a renewed sense of agency. Several participants described filling their days with domestic and outdoor tasks to maintain momentum and stave off worry: “I tell them my home is my kingdom, and I am, you know, occupying all my time. I wake up, go out, shop, Alhamdulillah, sleep, do sports, and walk on our farm” (P1). For others, attending important family events, despite physical pain, became both a duty and a coping mechanism, reinforcing emotional connections and life rhythms: “The month I came back, there was a ceremony in my daughter’s school because she was the first in class and had good marks. She was rewarded that day, and I was in pain, but I went because I wanted to support her” (P2). Maintaining an active social life also emerged as a key lifestyle choice for some participants to resist the isolating effects of illness: “I am thankful to Allah that I managed to maintain my social life throughout this journey. I meet up with family members regularly, go out with friends, and talk and laugh normally. I am living my life like I don’t even have this type of disease. I don’t even like to think about it while trying to enjoy my life” (P8). Meanwhile, some participants modified their social activities to avoid situations where they felt self-conscious about changes in their appearance, showing how coping behaviors could both enable and limit engagement: “Did you know I was so frustrated by my general appearance that I avoided going to certain places? I like to always be well put together and look my best when I go out. So, I didn’t like going to places where I didn’t look my best. Hence, I stayed away from weddings entirely and only went out to visit people” (P3).

Subtheme 3: lifestyle coping

This subtheme captures how participants coped by consciously maintaining or returning to their everyday lifestyles, routines, and social rhythms. Many emphasized their determination to live as normally as possible despite their diagnosis, choosing to continue daily activities, visit loved ones, go out in public, and focus on sources of happiness. For some, preserving normalcy was a deliberate act of psychological resilience. Whether through resuming social outings, avoiding negative thinking, or enjoying familiar pleasures such as nature or family time, participants described lifestyle continuity as a strategy to emotionally distance themselves from the illness and reassert their sense of self. A participant described lifestyle coping through the act of resuming her previous routine after stopping treatment: “Well, now, you know, I’ve stopped treatment, so it’s considered that I’ve returned to my previous normal condition. I go out, I like people” (P1). Another participant emphasized her determination to continue life as normally as possible despite her diagnosis. By insisting on maintaining her usual routines and spending time with her daughters: “After my cancer diagnosis, my life continued normally. I insisted on living my life as normally as I could, despite my condition. I also tried to go out with my daughters as much as possible” (P6). Some deliberately chose their social environments and who they share it with to bolster their mood, surrounding themselves with positive and uplifting companions who significantly impacted their own positivity: “I wanted to go out with people who were happy and didn’t have many worries in life. I wanted them to infect me with their bright spirits and happiness. The funny thing is that they know that I’m older than they are, but they like to think of me as their role model. I enjoyed this, so I decided that this is how I want to live my life from here on out” (P10). For others, continuity meant maintaining the same activities except for work, as one participant noted: “I think it’s normal, the same as it ever was before everything. The only difference is that I don’t go to work anymore” (P13). Even when treatment temporarily disrupted regular social contact, such as during chemotherapy when infection risk was high, women quickly reverted to their usual routines once medically able: “It’s normal, the same as it ever was before everything. I normally go visit relatives and go to social events. The only period I slightly stopped was during my chemotherapy. Mainly, because my immunity was low during that period, I was recommended not to expose myself to unnecessary risk of infection. Afterward, though, I resumed my life normally” (P14).

Discussion

This phenomenological study explored the lived experiences of Omani women diagnosed with stage I–III breast cancer, highlighting the complex emotional, cultural, spiritual, and social processes that shape their illness trajectory. Disease disclosure theme examines how participants chose to reveal their breast cancer diagnosis, the strategies they utilized in communicating (or concealing) this information, and the emotional consequences of those decisions. Disclosure emerged as a highly personal yet culturally informed act, in which women balanced the benefits of social support against the potential stigma or undesired pity. Participants retained control over their diagnostic information, deciding whether, when, and with whom to share it. When they limited disclosure, this was often intended to reduce distress among children or other family members whom they considered emotionally vulnerable. In this study, therefore, selective disclosure or nondisclosure referred to participants’ decisions not to share their diagnosis with others; it did not indicate that the women themselves were unaware of their diagnosis.

The present findings are most directly comparable with evidence from Arab settings. Al-Zaben et al. [17] found that Saudi mothers differed in whether and how they informed their children about the diagnosis. Avoiding frightening the child was among the reported reasons for delaying or withholding disclosure. Fearon et al.’s thematic analysis [9] similarly found that Arab women sometimes concealed their diagnosis to protect their family member, especially children, from emotional distress. Beyond Arab settings, comparable family-protective considerations have been reported in distinct cultural contexts. Miyata et al. [18] found that Japanese cancer patients hesitated to disclose their diagnosis so as not to disrupt family harmony. In both contexts, nondisclosure may reflect an effort to protect others from distress, although self-protection and other personal or contextual considerations may also influence such decisions. Similarly, Hilton et al. [19] reported that young adults in Western settings weighed moral obligations and social roles when deciding whether to disclose a cancer diagnosis, often withholding information to avoid distressing loved ones. Among Omani mothers, this strategic approach to disclosure aligns with Kazlauskaite et al. [20], who observed that breast cancer patients carefully plan how, when, and what to share with children in order to maintain emotional stability. Participants in the current study frequently delayed full disclosure until after surgery or early recovery, reframing the illness in terms of strength and healing. Such findings challenge psycho-oncological assumptions that openness is universally advantageous [17]. Studies by Li et al. [21] and Cheng et al. [22] similarly show that, in collectivist contexts, deliberate silence can function as an act of care, particularly to spare children emotional burden. Omani women in the current study echoed these sentiments, emphasizing that postponing disclosure helped protect household emotional equilibrium for children and other family members, while the resulting calm also supported the women’s own coping with the diagnosis. Withholding information until after key medical milestones enabled women to control the narrative, presenting their journey within a framework of resilience rather than vulnerability. Far from indicating emotional suppression, this selective silence represents a culturally rooted strategy for managing illness as a shared family responsibility, where the emotional stability of dependents and elders takes precedence over individual expression.

Support system in response to disclosure theme explores the sources of support that participants accessed after disclosing their illness and how these systems functioned emotionally and practically. In the current study, the magnitude and quality of support a woman received closely correlated with whom she informed about her cancer. Once a diagnosis was shared (even with a select few), a network of family, friends, colleagues, and healthcare providers rapidly mobilized. Familial support, especially from husbands and daughters, reflected both entrenched cultural expectations and evolving caregiving roles within Omani households, as women who had traditionally provided care within the family became recipients of emotional and practical support during treatment. Contrary to stereotypes of emotional distance, participants described logistical assistance and silent companionship during medical visits as important forms of support. This action-oriented model of support aligns with the observations of Al-Azri et al. [8] who noted that cancer can foster new patterns of intimacy and resilience under stress. Unlike Western narratives emphasizing verbal affirmations, Omani husbands’ restrained approach conveyed stability, presence, and quiet reliability, reflecting a culturally specific caregiving style in which emotional restraint signifies strength rather than detachment. Daughters emerged as central caregivers, providing emotional intimacy and practical assistance, from accompanying mothers to appointments and managing medications to mediating tense emotional situations. While their role parallels intergenerational norms common in collectivist societies, Omani daughters combined emotional protection with deference, motivated by birr al-walidayn (righteousness toward parents). Shekhani [23] noted that filial piety is a religious virtue expressed through quiet duty rather than overt concern. Zaman et al. [24] further explain that this ethic of care, grounded in discretion, modesty, and spiritual duty, challenges binary models of caregiving as hierarchical or dependent, highlighting instead a relational ethic of silent service and emotional containment. The extended family network also played a critical role. Sisters often actively provided daily caregiving and emotional support, while brothers contributed through transportation, financial aid, and shielding participants from external stressors. This network of support is not just anecdotal; it reflects a culturally embedded system of collective caregiving, deeply rooted in Omani social values and faith-based obligations. Setyawati et al. [25] described such collective caregiving as a moral response to illness in collectivist societies, where sickness becomes a shared family event rather than an individual burden. These networks not only address practical needs but also strengthen the patient’s sense of belonging and spiritual purpose, offering stability in times of vulnerability. In contrast to individualistic care models, where roles are typically formalized and assigned, Omani families naturally assume caregiving out of moral commitment and relational closeness [25].

Coping strategies theme examines the multidimensional approaches women employed to navigate the psychological and practical challenges of breast cancer. Their strategies extended beyond individual or biomedical solutions, drawing deeply on religious meaning systems and cultural norms. Participants leveraged both internal (spiritual and psychological) and external (behavioral and lifestyle) resources, with religious faith emerging as a predominant coping mechanism. Central to many accounts were the concepts of tawakkul (trust in divine will) and ṣabr (patience), even when these terms were not explicitly named. Participants consistently framed cancer as ibtilā’ (a divine test), transforming suffering into a morally and spiritually redemptive experience. This theological paradigm served two functions: First, it provided existential meaning. Viewing illness as divinely ordained enabled women to see their suffering as part of a larger moral order rather than arbitrary misfortune. This aligns with Pargament’s model of positive religious coping [26], in which faith provides a framework for managing adversity, alleviating existential anxiety and fostering acceptance. Second, it regulated emotional expression. Participants described suppressing overt displays of fear or distress, not as emotional avoidance but as dignified endurance rooted in religious commitment. Ahmadi and Rabbani [27] and Al-Azri et al. [28] similarly documented tawakkul among Muslim cancer patients, showing that trust in divine will can reduce anxiety about illness and death while reinforcing moral resilience. Rather than passive resignation, this spiritual labor represented an active reclamation of agency within suffering, turning vulnerability into an expression of devotion and strength. Alongside spiritual strategies, women engaged in deliberate behaviors to preserve normalcy and control. Consistent with global findings on problem-focused coping among cancer patients [29, 30], participants maintained routines, took on meaningful tasks, and remained socially active. Seiler and Jenewein [31] highlight that acceptance, social support, and active engagement buffer distress and enhance resilience among cancer patients. Participants in the current study were reinforcing their sense of identity and purpose, actively resisting the disempowerment that often comes with a cancer diagnosis. Examples included organizing desserts, making gatherings, coordinating salon visits, and participating in community events. These actions serve two important purposes. First, they promote direct problem-focused coping by preserving routines and reinforcing self-efficacy. Second, they facilitate emotion-focused coping by providing distraction, a sense of normalcy, and psychological relief outside the context of illness [32]. Within the Omani culture, living a “normal life” is itself a value that upholds dignity and emotional balance during therapy. By combining faith-based acceptance with purposeful action, women challenged the notion that coping must be passive, instead actively reclaiming control over their lives.

Study strengths and limitations

A key strength of this study is its phenomenological approach, which foregrounded the lived experiences of Omani women and enabled participants to describe their coping strategies in their own terms, generating culturally grounded insights that may be overlooked by standardized or Western-centric psychological instruments. The study also integrated religious and behavioral dimensions of coping by examining both Islamic spiritual frameworks and everyday behavioral adaptations, thereby providing a multidimensional account that was closely aligned with participants’ cultural worldviews. In addition, the study contributes culturally specific evidence to the limited literature on breast cancer coping in Oman and the wider Gulf region, with potential relevance for psychosocial support services, clinical practice, and public health policy. This contribution was further strengthened by the inclusion of Omani women with variation in age, educational background, and cancer stage, recruited from a national tertiary cancer center receiving referrals from across Oman. However, women with stage IV breast cancer and those who completed their treatment outside Oman were not represented. Consequently, the findings may not capture experiences associated with advanced disease or sustained engagement with overseas healthcare systems. Because the findings were derived from interview accounts, they reflect what participants felt comfortable verbalizing. Cultural norms surrounding modesty and emotional restraint may have led some participants to withhold or downplay vulnerable experiences, such as overt fear or distress, spiritual doubt, or nonmedical coping methods, potentially resulting in underreporting of perspectives that deviate from dominant cultural or religious expectations.

Conclusion

This phenomenological study provides a culturally informed perspective on how Omani mothers diagnosed with breast cancer manage illness disclosure, family and community responses, and coping strategies within a collectivist and faith-based framework. Disclosure was not just an act of sharing information; it was a relational and moral practice influenced by maternal responsibility, the emotional protection of loved ones, and culturally rooted norms of discretion and care. The choices to disclose, selectively share, or withhold information were intentional strategies aimed at maintaining family stability rather than acts of avoidance or denial. Family and community responses were crucial in shaping women’s experiences. Support came from emotionally restrained yet practical networks, where care was often demonstrated through presence, action, and silent reliability rather than explicit verbal reassurance. Husbands, daughters, siblings, and extended family members created interconnected systems of emotional and practical support, reflecting cultural and religious values that view caregiving as a shared moral obligation. However, women also had to navigate social sensitivities and potential stigma, indicating that the environment was not uniformly supportive and required careful management.

Coping strategies were multifaceted and deeply rooted in context, blending spiritual meaning-making, behavioral engagement, and lifestyle continuity. Religious faith, particularly the concepts of patience, trust in divine will, and acceptance of illness as a test, served as a strong framework for emotional regulation and resilience. In addition, women actively maintained their routines, social roles, and personal agency, challenging the idea that coping with illness is passive. They demonstrated adaptive strategies that combined acceptance with purposeful action. These findings highlight that disclosure, social response, and coping are interconnected aspects of women’s experiences with breast cancer, rather than separate processes. The study adds to the growing literature in psychosocial oncology by emphasizing culturally specific pathways through which mothers navigate illness within family systems. These findings have implications for psycho-oncological care, stressing the importance of culturally sensitive interventions that aid mothers in communication decision-making, recognize diverse expressions of support, and integrate spiritual and relational resources into care pathways. Future research should examine how tailored psychosocial interventions can support mothers and families throughout the cancer trajectory.

Author contributions

Conceptualization, H.H.A.S. and M.A.-A.; methodology, K.S.A.-A., H.H.A.S., A.S.A.F. and M.F.C.; software, K.S.A.-A.; validation, H.H.A.S., M.F.C. and M.A.-A.; formal analysis, K.S.A.-A.; investigation, K.S.A.-A. and Z.T.A.K.; resources, A.S.A.F. and Z.T.A.K.; data curation, K.S.A.-A.; writing original draft preparation, K.S.A.-A.; writing—review and editing, H.H.A.S. and M.A.-A.; supervision, H.H.A.S., A.S.A.F., M.F.C. and M.A.-A.; project administration, K.S.A.-A. and H.H.A.S. All authors have read and agreed to the published version of the manuscript.

Funding

Open access funding provided by Sultan Qaboos University.

Data availability

The data are not publicly available due to privacy and confidentiality considerations related to qualitative interview transcripts.

Declarations

Ethics approval

This study was approved by the Medical Research Ethics Committee of the Sultan Qaboos Comprehensive Cancer Care and Research Center (SQCCCRC) (Project ID CCCRC-20-2022).

Informed consent

Written informed consent was obtained from all participants involved in the study.

Competing interests

The authors declare no competing interests.

Clinical trial number

Not applicable.