In this study, we examined the decisions made by husbands of women diagnosed with BC and categorized their responses, with an emphasis on social decisions. Our analysis identified three categories: support for daily living, financial matters, and employment-related decisions. These findings highlight the specific nature and timing of social decisions.

Decisions regarding daily living support, such as those about housework and childcare, were most frequent. These findings align with previous research that a wife’s BC diagnosis often leads to substantial alteration in husbands’ household roles [9, 10, 14]. Consistent with prior studies [14], husbands often assume traditional female roles, taking on dual or even triple responsibilities. Similarly, Kong et al. noted that husbands struggle with these duties, with some even describing themselves as “Mr. Manny” [10]. Furthermore, husbands encountered specific challenges regarding children, including concerns about the hereditary transmission and the appropriate way to inform them about the illness. The increases in household responsibilities can heighten caregiver strain, particularly when there is insufficient preparation or confidence [15]. Furthermore, as Neris et al. noted, healthcare professionals often focus solely on the patient, overlooking the family’s social environment [14]. These findings underscore the urgent need for support in daily living for families, including their spouses.

Notably, this study adds a critical insight regarding timing: 68.7% (n = 57) related to daily living were made before the treatment or surgery. In the Japanese cultural context, where traditional gender divisions of labor remain significant [16], husbands often internalize implicit gender norms [17] that emphasize instrumental roles. This internalization aligns with gender role theory, explaining why husbands adopt a ‘protector’ identity, rooted in cultural expectation to safeguard the family through practical actions. Consequently, consistent with coping theory [18], they tend to prioritize problem-focused coping over emotional processing as a means of fulfilling these perceived societal expectations. By expeditiously establishing logistical and financial arrangements immediately following the diagnosis, husbands likely aim to restore family stability and regain a sense of control, effectively acting as the primary problem-solver within the family system before the uncertainty of medical treatment begins.

This study also highlights the importance and complexity of child-related decision-making. Among those who made these decisions, 64% (n = 16) considered them of significant importance, and this was the sole category rated as very difficult (12%, n = 3). Although there was only one respondent mentioned the timing of pregnancy, it remains a crucial consideration for young couples concerned about the impact of treatment on fertility. Previous studies have highlighted that male partners receive information and communicate about fertility [9]. These findings suggest that childcare and family planning responsibilities impose a significant burden on employed men. Therefore, healthcare professionals must provide prompt practical assistance that encompasses not just treatment plans but also specific daily living decisions, such as childcare and fertility preservation, commencing as early as possible after the diagnosis.

Decisions related to financial matters were the second most frequent category, with a notable 87.9% (n = 29) occurring before treatment initiation. While patients with BC must simultaneously navigate complex treatment decisions [20, 21], our findings suggest that they engage in broader financial management at an earlier stage. Given that the year following diagnosis is recognized as a particularly financially challenging period often requiring economic sacrifices during this period [15, 19], this proactive approach likely reflects a strategy to manage the impending “financial toxicity,” such as income reduction and out-of-pocket expenses [9, 22,23,24]

Of the participants responsible for decisions regarding medical expenses, 50% (n = 13) expressed a high level of satisfaction with their decisions. Effective financial management is a crucial factor in mitigating caregiver stress [15]. Consequently, medical professionals can alleviate caregiver burden by providing information on financial support systems and insurance policies immediately upon diagnosis.

Decisions regarding employment are inextricably linked to the financial stability discussed above. In this study, 69.6% (n = 16) of employment decisions were made before treatment initiation. Although the absolute number of these decisions was smaller than other categories, the burden on husbands was disproportionately high, often necessitating significant professional adjustments as anticipated from prior research [25, 26].

Notably, however, distinct satisfaction was observed: all three men who resigned and 50% (n = 3) of those who took a leave of absence rated their decisions as very important and satisfactory. This suggests that prioritizing their wife’s care, despite temporary financial concerns, yields high satisfaction in terms of personal values and contributions to the partnership.

Nevertheless, structural support remains critical. Given the known economic strain on employed caregivers, companies should enhance caregiver support programs—including flexible work schedules, telecommuting, and clarification, and clear leave policies [9, 10, 15, 25, 26]. Policymakers should likewise recognize husbands as care partners and implement proactive measures such as paid family leave [9, 15].

Finally, the impact of employment change on patient outcome warrants attention. Veenstra et al. found that while employment changes by non-spousal supporters correlated with declined patients’ health-related quality of life and increased financial burden, no such negative association was observed for spouses [26]. This implies that spousal support may have a unique buffering effect. Future research should therefore investigate the impact of primary supporter’s employment decisions on patient outcomes.

Our findings show that social decisions are concentrated before medical treatment before medical treatment begins, as husbands act swiftly to stabilize their family’s foundation. This challenges traditional norms that distance man from the sphere of care [10, 16]. Consequently, healthcare professionals should not wait for treatment to begin but provide a “Decision-making Guideline” at diagnosis. This checklist facilitates the “role shift” by addressing domestic roles (chores, parenting), work adjustment, and financial matters. Such early intervention empowers husbands as essential care team members and stabilizes the family’s social and economic well-being.

This study had a few limitations. First, this study is subject to selection bias due to the reliance on panel registrants from a marketing research company. Participants were limited to those with internet access and a willingness to participate in online surveys, which limits the generalizability of the findings to the general population of male spouses. However, regarding cultural generalizability, it is worth noting that although the findings were obtained from a Japanese sample, they are likely more applicable to societies with similar family structures and gender roles (such as many Asian countries) than to Western societies. Second, the cross-sectional design of this study limits our ability to establish causal relationships between the participants’ characteristics and their social decisions, or to assess the long-term outcomes of these decisions. Furthermore, longitudinal studies are essential to examine how decisions, such as leave of absence or resignation by the husband, affect household finances, marital relationships, and the quality of life of both spouses. Third, we were unable to ascertain whether the respondents served as primary caregivers for their wives, leaving the extent of the caregiving burden they experienced undetermined. Fourth, the reliance on data collected through a self-administered questionnaire as opposed to in-depth interviews, resulted in participants often listing decisions in bullet points. This approach lacks contextual detail, thereby limiting our ability to fully interpret their meaning and background.

Future research should incorporate couple-pair surveys to gain insights into wives’ perceptions and evaluations of their husbands’ decisions and support. Despite these limitations, this study is noteworthy for its detailed examination of non-treatment-related decisions made by husbands following their wives’ cancer diagnosis.