6
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective

          Contemporary approaches to medical decision-making advise that clinicians should respect patients’ decisions. However, patients’ decisions are often shaped by heuristics, such as being guided by emotion, rather than by objective risk and benefit. Risk-reducing mastectomy (RRM) decisions focus this dilemma sharply. RRM reduces breast cancer (BC) risk, but is invasive and can have iatrogenic consequences. Previous evidence suggests that emotion guides patients’ decision-making about RRM. We interviewed patients to better understand how they made decisions about RRM, using findings to consider how clinicians could ethically respond to their decisions.

          Methods

          Qualitative face-to-face interviews with 34 patients listed for RRM surgery and two who had decided against RRM.

          Results

          Patients generally did not use objective risk estimates or, indeed, consider risks and benefits of RRM. Instead emotions guided their decisions: they chose RRM because they feared BC and wanted to do ‘all they could’ to prevent it. Most therefore perceived RRM to be the ‘obvious’ option and made the decision easily. However, many recounted extensive post-decisional deliberation, generally directed towards justifying the original decision. A few patients deliberated before the decision because fears of surgery counterbalanced those of BC.

          Conclusion

          Patients seeking RRM were motivated by fear of BC, and the need to avoid potential regret for not doing all they could to prevent it. We suggest that choices such as that for RRM, which are made emotionally, can be respected as autonomous decisions, provided patients have considered risks and benefits. Drawing on psychological theory about how people do make decisions, as well as normative views of how they should, we propose that practitioners can guide consideration of risks and benefits even, where necessary, after patients have opted for surgery. This model of practice could be extended to other medical decisions that are influenced by patients’ emotions.

          Related collections

          Most cited references27

          • Record: found
          • Abstract: found
          • Article: not found

          An integrative model of shared decision making in medical encounters.

          Given the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions. In April 2005, we ran a Pubmed (Medline) search to identify articles published through 31 December 2003 with the words shared decision making in the title or abstract. The search yielded 681 citations, 342 of which were about SDM in the context of physician-patient encounters and published in English. We read and reviewed the full text of all 342 articles, and got any non-redundant references to SDM, which yielded an additional 76 articles. Of the 418 articles examined, 161 (38.5%) had a conceptual definition of SDM. We identified 31 separate concepts used to explicate SDM, but only "patient values/preferences" (67.1%) and "options" (50.9%) appeared in more than half the 161 definitions. Relatively few articles explicitly recognized and integrated previous work. Our review reveals that there is no shared definition of SDM. We propose a definition that integrates the extant literature base and outlines essential elements that must be present for patients and providers to engage in the process of SDM. The integrative definition of SDM is intended to provide a useful foundation for describing and operationalizing SDM in further research.
            Bookmark
            • Record: found
            • Abstract: not found
            • Book: not found

            The Quality of Qualitative Research

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment.

              Many patients with unilateral breast cancer choose contralateral prophylactic mastectomy to prevent cancer in the opposite breast. The purpose of our study was to determine the use and trends of contralateral prophylactic mastectomy in the United States. We used the Surveillance, Epidemiology and End Results database to review the treatment of patients with unilateral breast cancer diagnosed from 1998 through 2003. We determined the rate of contralateral prophylactic mastectomy as a proportion of all surgically treated patients and as a proportion of all mastectomies. We identified 152,755 patients with stage I, II, or III breast cancer; 4,969 patients chose contralateral prophylactic mastectomy. The rate was 3.3% for all surgically treated patients; 7.7%, for patients undergoing mastectomy. The overall rate significantly increased from 1.8% in 1998 to 4.5% in 2003. Likewise, the contralateral prophylactic mastectomy rate for patients undergoing mastectomy significantly increased from 4.2% in 1998 to 11.0% in 2003. These increased rates applied to all cancer stages and continued to the end of our study period. Young patient age, non-Hispanic white race, lobular histology, and previous cancer diagnosis were associated with significantly higher rates. Large tumor size was associated with a higher overall rate, but with a lower rate for patients undergoing mastectomy. The use of contralateral prophylactic mastectomy in the United States more than doubled within the recent 6-year period of our study. Prospective studies are needed to understand the decision-making processes that have led to more aggressive breast cancer surgery.
                Bookmark

                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                26 May 2017
                2017
                : 12
                : 5
                : e0178392
                Affiliations
                [1 ]Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
                [2 ]Hull York Medical School, Hull, United Kingdom
                [3 ]Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
                [4 ]Royal Liverpool Women’s Hospital NHS Trust, Liverpool, United Kingdom
                Tata Memorial Centre, INDIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: SLB DW HB CH SH P. Salmon.

                • Data curation: HGF P. Saini.

                • Formal analysis: SLB HGF P. Saini DW P. Salmon.

                • Funding acquisition: SLB HB CH P. Salmon.

                • Investigation: HGF P. Saini.

                • Methodology: SLB DW HB LF P. Salmon.

                • Project administration: SLB P. Saini.

                • Resources: HB LG CH SH LF.

                • Supervision: SLB P. Salmon.

                • Validation: SLB HGF P. Saini P. Salmon.

                • Visualization: SLB P. Saini.

                • Writing – original draft: SLB DW HGF P. Saini P. Salmon.

                • Writing – review & editing: CH SH LG.

                Author information
                http://orcid.org/0000-0002-6142-0995
                Article
                PONE-D-16-42283
                10.1371/journal.pone.0178392
                5446175
                28552971
                b51c07ce-bae7-4d8d-98b4-5c790d995af6
                © 2017 Brown et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 24 October 2016
                : 14 May 2017
                Page count
                Figures: 0, Tables: 1, Pages: 13
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000269, Economic and Social Research Council;
                Award ID: ES/J008184/1
                Award Recipient :
                This research was entirely funded by the Economic and Social Research Council (UK) Grant ES/J008184/1. ESRC did not seek to influence the conduct of the investigation or this report.
                Categories
                Research Article
                Biology and Life Sciences
                Psychology
                Emotions
                Fear
                Social Sciences
                Psychology
                Emotions
                Fear
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Decision Making
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Decision Making
                Social Sciences
                Psychology
                Cognitive Psychology
                Decision Making
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognition
                Decision Making
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Medical Doctors
                Surgeons
                People and Places
                Population Groupings
                Professions
                Medical Doctors
                Surgeons
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Medical Doctors
                Physicians
                Surgeons
                People and Places
                Population Groupings
                Professions
                Medical Doctors
                Physicians
                Surgeons
                Social Sciences
                Sociology
                Education
                Schools
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Reproductive System Procedures
                Mastectomy
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Surgical Excision
                Mastectomy
                Biology and Life Sciences
                Genetics
                Mutation
                Biology and Life Sciences
                Psychology
                Emotions
                Social Sciences
                Psychology
                Emotions
                Custom metadata
                All data files are available from the UK Data Service database (10.5255/UKDA-SN-851946) at https://discover.ukdataservice.ac.uk/catalogue/?sn=851946&type=Data%20catalogue.

                Uncategorized
                Uncategorized

                Comments

                Comment on this article

                scite_
                0
                0
                0
                0
                Smart Citations
                0
                0
                0
                0
                Citing PublicationsSupportingMentioningContrasting
                View Citations

                See how this article has been cited at scite.ai

                scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

                Similar content243

                Cited by7

                Most referenced authors315