Cancer is a leading cause of death worldwide, affecting both adults and children [1] . The disease has a profound impact on the mental health of patients, leading many to seek coping mechanisms. Group therapy has been recommended as part of the treatment plan for cancer patients to help them manage the psychological strain [2] . A pivotal study by Spiegel et al. [3] on group therapy for breast cancer patients laid the foundation for psychosocial cancer care practices, demonstrating the benefits of improving psychological health and extending survival. Research indicates that the prognosis for breast cancer patients is influenced by their participation in psychosocial interventions [2] [3] [4] [5] . The goal of supportive-expressive group therapy is to help patients embrace life more fully, despite their life-threatening illness [3] .

Spiegel et al.’s [3] model incorporated Yalom’s [6] principles of group process. Yalom emphasized the importance of cohesion in achieving psychological well-being and healing. Cohesion refers to the relationships between the group members, including the leader. Cohesion creates an atmosphere of unconditional acceptance, dissipates feelings of shame and isolation, and assures individuals that they are not alone in their struggles [7] . Sharing existential concerns and discussions of death and dying promote cohesion within group therapy, enabling individuals to confront their fears [8] . Emotional disclosure facilitates interconnectedness among members, allowing the group to evolve as an integrated and whole system [9] . Contemporary studies have expanded on Spiegel et al.’s model [3] by adopting a systemic viewpoint that encourages new ways of relating among group members. This approach allows individuals to assert their own contributions in self-care, create futures for themselves, and make new commitments to their families and communities.

Jung’s [10] theory of the collective unconscious provides a framework that addresses the interconnectedness among human beings as part of a larger context. Jung [10] describes the collective unconscious as follows: “The collective unconscious is detached from anything personal and is common to all men [sic] since its contents can be found everywhere, which is naturally not the case with personal content” (p. 66). Jung’s theory incorporates cosmic processes and spirituality into everyday life, embracing the diversity, culture, spirituality, and way of life of affected women and their communities [11] . It operates within fluid and permeable boundaries between the sick, the healer, and the community members, including elders [12] [13] . Indigenous healing practices emphasize communal and inclusive approaches with the full participation of others.

To date, only a few studies in psycho-oncology have adopted a collective unconscious and systemic approach, by incorporating family members, spouses, children, and community members in interventions aimed at improving the quality of life for women diagnosed and treated for breast cancer. The systemic approach recognizes the significance of collective creativity in altering and renegotiating identities for the larger whole [14] . Such an approach can be beneficial in alleviating cancer outcomes and improving survivorship, as it values the presence of multiple realities [15] .

In their study, Rettger et al. [16] incorporated Psycho-Spiritual Integration Therapy (PSIT) practice in the group process and found that women were able to develop inner processing that increased personal control to actualize life purpose. Similarly, Patel et al. [17] adopted PSIT practice in their group process and discovered that women expanded their sense of self and developed new meanings for their lives. From a collective unconscious perspective, spirituality deepens connections to life and enhances relationships with oneself, others in the community, the environment, and something greater than oneself [18] . Furthermore, the collective unconscious aligns with indigenous worldviews, emphasizing spirituality as a way of being. Including spirituality in group processes introduces a new way of facilitating immersion [19] . For example, healing rituals conducted by indigenous healers can have implications for the group process, aligning with an understanding of the meaning of illness and the messages communicated by ancestors. Such rituals deepen spiritual experiences within relationships and promote cohesion in unique ways, contributing to individual and community well-being [20] .

For Jung, the collective unconscious refers to the objective part of the psyche containing shared patterns of behavior among all human beings [21] . In a similar vein, Ullman [22] applied the notion of the “social unconscious” (p. 26). According to Ullman [22] , the social unconscious pertains to the socialization process, where individuals may be unaware of the impact of external social factors on their lives. Fromm [23] introduced the concept of the social unconscious to describe information revealed in dreams about the existence and constraints of social, cultural, and communicational arrangements of which individuals remain unaware (p. 14). Furthermore, Hopper [24] explains that the social unconscious can manifest when people unconsciously recreate situations that have occurred in the past, presenting the new situation as equivalent to the previous one. Hopper [24] argues that, within a family system, groups can re-enact various aspects of social trauma from another time and place. Untreated unresolved trauma within the family system necessitates therapeutic intervention, as it can impede growth and development [24] .

Jung’s theory of the collective unconscious posits that dreams reveal psychological processes with historical, collective, mythological, and ancestral significance [10] . Jung’s model encompasses both the individual and the community. His archetypes align with indigenous worldviews, seeking to restore wholeness [25] . Similarly, aboriginal peoples’ concepts of health and healing emphasize interconnectedness, balance, and holism, which encompass the family, environment, and community contexts [26] .

A systemic approach is a framework to structure cancer support and interventions

The ecosystem orientation considers the family as a natural, rule-governed system, wherein changes in one part of the system impact the entire system [27] . The systemic orientation can lead to first-order and second-order change [28] . First-order change involves modifying the activities of specific system components to enable adaptation in response to external changes [29] . For instance, within an organization, managers might decide to reduce production rates due to a decline in sales resulting in increased stock levels [14] . On the other hand, second-order change involves altering the organization of the system by introducing new rules that govern relationships [29] . Second-order change focuses on the language used to develop critical consciousness. Change occurs through meaning-making processes that are integral to the dialogue, leading to the evolution of new rules governing each subsystem and its relationship to the entire system. Within this perspective, change unfolds during dialogue, where members share their stories and express their perspectives [30] . The systems theory framework emphasizes the importance of relationships and connections among different parts of the system [28] .

In the literature, there is limited research that investigates the impact of breast cancer experiences on spouses, partners, and families of the patients [31] - [36] . Those who are affected by breast cancer experience (such as the spouses and family members) may be granted an opportunity to understand the meaning of their experiences and adapt to their new version of reality [37] . From a transformational viewpoint, the participation of spouses in the healing process may promote wholeness [38] . Breast cancer illness may expand spouses’ consciousness, enabling them to appreciate gender differences, demonstrate empathy, and show compassion and respect for others [39] . Through breast cancer illness, spouses may engage in emancipatory learning to gain awareness and meaning of what their significant others communicate concerning their emotions [40] . Spouses may acquire a new meaning structure, and may potentially grow and develop new insights that can renew purpose in their marital life.

This paper aims to conduct a systematic literature review to identify interventions specifically delivered in low-resource settings for women diagnosed with breast cancer. To date, only a limited number of studies in psycho-oncology have embraced a collective unconscious and systemic approach, by involving family and community members in interventions aimed at improving the quality of life for women diagnosed and treated for breast cancer. The systemic approach is a framework that recognizes the importance of collective creativity in altering, renegotiating, and developing new identities for the affected person’s broader whole [9] . This review will also encompass non-Western cultures, including African American women, Latinos, Chinese American women in the United States, aboriginal women in Canada, indigenous native women in Australia, and those in Indonesia. The review will also explore how current psychosocial interventions can meet the needs of indigenous native and Black African women diagnosed with breast cancer in developing nations, specifically within the African continent.

A comprehensive computerized literature search was conducted using MEDLINE via EBSCOHost, CINAHL, PsychInfo, Google search, PubMed, and indigenous collection databases. The search terms included: breast cancer intervention, Black women, psychosocial intervention for indigenous people (women), women from non-Western cultures, and African American, Chinese American, and Latino women diagnosed with breast cancer. Furthermore, psychosocial interventions for non-western cultures such as Indonesia, Malaysia, and African countries were included in the search. The search was not restricted by publication date. The criteria for manuscript eligibility included both unpublished doctoral dissertations and published peer-reviewed articles. Qualitative and mixed-method research studies were selected, as they provided valuable insights into participants’ personal experiences [41] . The search also involved the application of indigenous-based methods, such as circles, to give voice to vulnerable populations [42] . Additionally, the reference lists of retrieved publications and reviews were manually searched to ensure comprehensive coverage.

Inclusion criteria used to select reviewed studies

The search aimed to identify studies that met specific criteria related to breast cancer interventions for indigenous Black African, native, and aboriginal women. Out of the 32 studies reviewed, eight focused on needs assessment, while 24 examined emerging interventions in the developmental stages. In line with Jung’s theory of the collective unconscious, which incorporates cosmic processes and spirituality, relevant studies that incorporated spirituality in their practice [16] [17] [33] [43] - [49] were included in the review. Studies that aligned with the collective unconscious and systemic approach framework were also selected.

Regarding cancer support care interventions and practices, only studies that aligned with a systemic framework emphasizing relationships and connections among various parts of the client system were included [4] [32] [33] [34] [36] [44] [45] [47] [50] - [58] . The review also included studies focusing on change implications of meaning-making processes [59] [60] and dialogue through which members share their stories and learning experiences [5] [46] [56] [61] [62] .

To ensure the inclusion of studies applicable to indigenous participants, the checklist of eight dimensions developed by Huria et al. [63] was employed. The CONSIDER reporting process criteria [63] guided the assessment, with a focus on participation, methodologies, relationships, and capacity. Indigenous identity was a criterion for participation, and research reports were expected to include details of indigenous leadership, participant recruitment, participant confidentiality, and the consenting process. Indigenous community members were involved in data analysis, and research relationships were characterized by meaningful engagement and ethical processes. The expertise and capacity of indigenous participants and stakeholders were matched with their involvement in the research process.

In total, 21 studies were reviewed, and selected based on collaborative research efforts aimed at building community capacity [64] . Collaborative research involved the inclusion of indigenous community members and elders, while qualitative methodologies were favored to give voice to indigenous people. Oral data collection methods such as traditional interviews, focus groups, circles, and storytelling were utilized to capture proximal immediacy and valued sources of knowledge in indigenous cultures. Methods like photo-voice, circles, and storytelling allowed participants to share their experiences and perspectives. Circles, viewed holistically in indigenous cultures, served as a means of passing down stories, promoting healing, and facilitating intergenerational learning. Songs were recognized as a form of contemplative knowledge, enabling spiritual awakening and providing deep cultural insights into the earth and nature.

The themes were extracted using thematic content analysis [65] . Themes were developed from the codes (and collated data) across all data items in the entire dataset. Using Jung’s collective unconscious theory as a framework that incorporated spirituality in cancer support care the following themes were identified: 1) inclusion of spirituality; 2) community-based interventions can establish a social support network; 3) wider and blended participation can include families, caregivers, friends, and prayer team members. In addition, the systemic approach framework included the themes: 1) capacity to build cohesion among participants; 2) the meaning-making process is co-created by all participants; and 3) incorporated direct learning through experience.

Out of the 32 studies reviewed, eight focused on needs assessment, while 24 focused on emerging interventions at the developmental stages. The paper aimed to systematically review and identify feasible interventions for women diagnosed with breast cancer in low-resource settings. The framework employed for these interventions incorporates spirituality, family members, spouses, children, and community members, using both collective unconscious and systemic approaches to improve the quality of life for women undergoing breast cancer diagnosis and treatment. The systemic approach recognizes practices that enhance participants’ capacity and reshape their meaning-making processes, allowing for the renegotiation and development of new identities within the larger whole [9] .

Four main findings were reported from the systematic review. First, 50% of the relevant studies and practices emphasized relationships and connections [32] [33] [36] [44] [45] [47] [50] - [58] . Researchers have found strength in socially supportive relationships as a source of positive well-being promotion [75] . It is important to empower participants to share their needs, stories, and captured images, prioritizing community knowledge [51] . Developing social support resources that meet the psychosocial needs of non-western women can enhance their cancer outcomes and prognosis. For instance, these can include individual sessions through telephone or private visits at home, engagement of peer mentors to build open relationships and harmony, and coordination of information sessions to minimize misunderstandings and communication gaps. Transforming school gardens or empty classrooms into socially supportive resources after school hours can improve community members’ access to services [75] .

Second, approximately 33% of the reviewed studies and practices incorporated spirituality [16] [17] [33] [43] - [49] [66] . Outside church services, church buildings in low-income urban areas can be utilized and incorporate spiritual interventions (worship, prayer, etc.). Participation of traditional healers and herbalists in primary healthcare interventions can expand the benefits, offering significant outcomes and additional social support resources in community non-medical settings.

Third, 10% of the studies noted that informal family interactions in home and community settings can play an indispensable role in alleviating the outcomes of cancer. Studies incorporating family [32] [36] [47] [50] [53] [54] [66] and studies that have formally included family members [4] [52] have revealed that the cancer experience is a collective journey involving family and friends, providing an opportunity for spiritual growth among non-western women diagnosed and treated for breast cancer. Joint activities such as video-making, knitting or sewing, and nutrition education (learning how to grow a vegetable garden) can be coordinated.

Fourth, 7% of the studies and practices focused on altering meaning-making processes [59] [60] and facilitating new knowledge and learning experiences through dialogue [5] [46] [56] [61] [62] . In the past, indigenous native women hesitated to actively participate in support groups due to fear of provocation and cold interactions with professionals [51] . Activities such as dance-movement classes and fitness, poetry lessons, storytelling or writing classes, photography classes, and “play-form” associations such as dream-sharing and drawing can be offered, and the participation of spouses, families, caregivers, and friends of women can be encouraged to promote sustainability.

Community-based interventions are valuable in low-resource settings. It is therefore beneficial to develop social support resources that can meet the psychosocial needs of non-western women in order to enhance their prognosis and cancer outcome. The review highlights the importance of practices that develop capacity through cohesion among participants, co-creation of meaning-making processes, and a commitment to new ways of being, leading to whole-system change. For non-western (indigenous native and African) women, successful psychosocial interventions should incorporate spirituality, kin networks, and oral storytelling, and take place in culturally welcoming environments that foster trust [51] .

There are limited empirical studies focused on indigenous native and Black African women’s psychosocial needs during the treatment phase for breast cancer. Replication studies are needed to further explore the effectiveness of culturally sensitive intervention approaches that incorporate the contextual aspects of socioeconomic status, colonial legacy, and marginalization of those affected by breast cancer. The implication of establishing social support resources in communities is the potential development of multidisciplinary teams consisting of primary healthcare practitioners, traditional healers, and herbalists who can offer a holistic service that could turn around the plight of late diagnosis for indigenous native and Black African women.

This work is based on research supported by the National Institute for the Humanities and Social Sciences.

There is no conflict of interest present in this article.

Lekeka, M. (2023) Psychosocial Group Intervention at a Low-Resource Setting Environment for Women Who Are Diagnosed and Treated for Breast Cancer: A Systematic Review. Health, 15, 1150-1170. https://doi.org/10.4236/health.2023.1510077