Background <p>Few studies have explored the impact that children—and grandchildren—have on treatment decisions in metastatic breast cancer (mBC). This study examined whether or not being a parent or grandparent influences treatment decisions.</p> Methods <p>A qualitative sub-analysis was conducted with a purposive, diverse sample of 13 women with mBC in the Southeastern United States. Semi-structured interviews explored treatment decision-making, patient values, and patient-clinician communication. Transcribed interviews were analyzed using thematic analysis by three independent coders to identify recurrent themes.</p> Results <p>Nearly half (<i>n</i> = 6, 46%) of participants were women of color, and 12 had children. Seven themes emerged as key factors in treatment decision-making, with five participants identifying children and grandchildren as critical. Other common factors included side effects (<i>n</i> = 7, 54%) and quality of life (<i>n</i> = 6, 46%). Among participants with children and grandchildren, body image emerged as a subtheme. For those prioritizing quality of life and managing side effects, children provided emotional support and assistance with daily activities.</p> Conclusions <p>Children and grandchildren significantly influenced treatment decisions, rivaling quality of life and side effects as critical factors. This influence varied by life stage, with younger mothers prioritizing treatment efficacy and older women valuing quality of life and emotional support. Our results demonstrate that continuous shared decision-making is crucial as treatment preferences evolve and are influenced by familial roles and disease progression.</p> Implications <p>Future tools should include an assessment that integrates family and children. This approach can better support survivors in aligning treatment with their values and familial priorities.</p>