Predicting women's intentions for contralateral prophylactic mastectomy: An application of an extended theory of planned behaviour

Richards, Imogen; Tesson, Stephanie; Porter, David; Phillips, Kelly‐Anne; Rankin, Nicole; Musiello, Toni; Marven, Michelle; Butow, Phyllis

doi:10.1016/j.ejon.2015.12.002

Cited by 10 publications

(5 citation statements)

References 37 publications

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“…Thus, mapping our findings onto the Theory of Planned Behavior (TPB) contributes to advancing novel, tailored family interventions promoting cancer predisposition cascade genetic testing for BRCA . This theoretical contribution towards developing complex interventions promoting cascade screening is further supported by the demonstrated utility of the TPB in breast cancer and genetic counseling [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

Section: Discussionmentioning

confidence: 97%

“…Accordingly, the United Kingdom Medical Research Council recommends integrating relevant theories/frameworks when developing complex interventions [ 23 ]. One theory, the Theory of Planned Behavior (TPB) [ 24 ], has been effectively used in the context of breast cancer to describe a wide range of cancer-related behaviors including screening/mammography [ 25 ], risk-reducing surgeries [ 26 , 27 ], lymphedema risk reduction activities [ 28 ], adherence to adjuvant endocrine therapies [ 29 ], as well as contacting potentially at-risk relatives [ 30 ]. Similarly, the TPB has been employed in the field of genetic counseling [ 31 ] to better understand and predict behaviors around prenatal genetic testing [ 32 ] and expanded carrier screening [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

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Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening

Dwyer

Hesse‐Biber

Flynn

et al. 2020

Cancers

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Pathogenic germline variants in Breast Cancer 1/2 (BRCA) genes confer increased cancer risk. Understanding BRCA status/risk can enable family cascade screening and improve cancer outcomes. However, more than half of the families do not communicate family cancer history/BRCA status, and cancer outcomes differ according to parent of origin (i.e., maternally vs. paternally inherited pathogenic variant). We aimed to explore communication patterns around family cancer history/BRCA risk according to parent of origin. We analyzed qualitative interviews (n = 97) using template analysis and employed the Theory of Planned Behavior (TPB) to identify interventions to improve communication. Interviews revealed sub-codes of ‘male stoicism and ‘paternal guilt’ that impede family communication (template code: gender scripting). Conversely, ‘fatherly protection’ and ‘female camaraderie’ promote communication of risk. The template code ‘dysfunctional family communication’ was contextualized by several sub-codes (‘harmful negligence’, ‘intra-family ignorance’ and ‘active withdrawal of support’) emerging from interview data. Sub-codes ‘medical misconceptions’ and ‘medical minimizing’ deepened our understanding of the template code ‘medical biases’. Importantly, sub-codes of ‘informed physicians’ and ‘trust in healthcare’ mitigated bias. Mapping findings to the TPB identified variables to tailor interventions aimed at enhancing family communication of risk and promoting cascade screening. In conclusion, these data provide empirical evidence of the human factors impeding communication of family BRCA risk. Tailored, theory-informed interventions merit consideration for overcoming blocked communication and improving cascade screening uptake.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening

Dwyer

Hesse‐Biber

Flynn

et al. 2020

Cancers

View full text Add to dashboard Cite

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“…More women with early‐stage, unilateral breast cancer and low genetic risk are choosing contralateral prophylactic mastectomy (CPM) . This trend is increasing, despite evidence that the risk for developing cancer in the healthy breast is low and that removing the unaffected breast does not confer a survival advantage or quality of life benefit . Moreover, CPM has been associated with higher risks of surgical complications and reoperations.…”

Section: Introductionmentioning

confidence: 99%

“…Findings from a single institution study suggest that most women with a suspicious finding in their healthy breast on a presurgical MRI chose to forgo a biopsy and proceed directly to CPM, and the majority who had genetic testing chose CPM regardless of the results . Such counterintuitive findings suggest that women's decisions to have CPM are driven by a complex interplay of factors, many of which are not well understood …”

Section: Introductionmentioning

confidence: 99%

Reframing the conversation about contralateral prophylactic mastectomy: Preparing women for postsurgical realities

et al. 2018

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Objective: Women with unilateral, early-stage breast cancer and low genetic risk are increasingly opting for contralateral prophylactic mastectomy (CPM), a concerning trend because CPM offers few clinical benefits while increasing risks of surgical complications. Few qualitative studies have analyzed factors motivating this irreversible decision. Using qualitative methods, this study sought to understand women's decision making and the impact of CPM on self-confidence, sense of femininity, sexual intimacy, and peace of mind.Methods: Women who had CPM within the last 10 years were recruited to participate in the study. We conducted a thematic analysis of the data.Results: Forty-five women were interviewed. When making the decision for CPM, most had incomplete knowledge of potential negative outcomes. However, all believed CPM had more benefits than harms and would confer the most peace of mind and the fewest regrets should cancer return. They knew their contralateral breast cancer risk was low but were not persuaded by statistics. They wanted to do everything possible to reduce their risk of another breast cancer, even by a minimal amount, but most reported paying an unexpectedly high price for this small reduction in risk. Nevertheless, 41 of 45 reported that they would make the same decision again.Conclusions: These findings highlight an opportunity for physicians to reframe the conversation to focus on the patient experience of the tradeoffs of CPM rather than statistical odds of future cancers. Our findings suggest that more data may not dissuade women from CPM but may better prepare them for its outcomes. KEYWORDS breast cancer, breast cancer surgery, cancer, contralateral prophylactic mastectomy, CPM, decision-making, oncology, psychosocial, quality of life, surgery

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“…To date, no studies have investigated the impact of a history of psychological distress on thyroid cancer management, while a study on prostate cancer showed that anxiety was a significant predictor of surgical treatment receipt, despite risks such as impotence and urinary incontinence [14]. Furthermore, breast cancer patients with higher levels of anxiety were more likely to elect for contralateral prophylactic mastectomy despite limited evidence that CPM improves survival [11,15]. Such differences between treatment decision making can be quantified by measuring the interval between diagnosis and treatment (TTI).…”

Section: Introductionmentioning

confidence: 99%

Anxiety and Depression as Potential Predictors for Shorter Time to Undergo Initial Surgical Treatment for Papillary Thyroid Cancer

Vujovic,

Alsen,

Vasan

et al. 2024

Cancers

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(1) Background: A pre-existing psychiatric condition may impact decision making by patients and/or physicians following a thyroid cancer diagnosis, such as potentially electing surgery over active surveillance, thus shortening the time to cancer removal. This is the first study to investigate the association between pre-existing anxiety and/or depression and time to receive surgical treatment for thyroid cancer. (2) Methods: Retrospective data were collected from 652 surgical thyroid cancer patients at our institution from 2018 to 2020. We investigated the time between thyroid cancer diagnosis and surgery, comparing patients with pre-existing anxiety and/or depression to those without. (3) Results: Patients with anxiety, depression, and both anxiety and depression had a significantly shorter time between diagnosis and surgery (51.6, 57, and 57.4 days, respectively) compared to patients without (111.9 days) (p = 0.002, p = 0.004, p = 0.003, respectively). (4) Conclusions: Although little is known about the impact of pre-existing psychiatric conditions in the decision-making process for thyroid cancer surgery, this present study showed that anxiety and/or depression may lead to more immediate surgical interventions. Thus, psychiatric history may be an important factor for physicians to consider when counseling patients with thyroid cancer.

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Predicting women's intentions for contralateral prophylactic mastectomy: An application of an extended theory of planned behaviour

Cited by 10 publications

References 37 publications

Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening

Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening

Reframing the conversation about contralateral prophylactic mastectomy: Preparing women for postsurgical realities

Anxiety and Depression as Potential Predictors for Shorter Time to Undergo Initial Surgical Treatment for Papillary Thyroid Cancer

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