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    Contralateral Prophylactic Mastectomy: An Exploratory Approach to Understanding the Decision Making Process

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    Genre
    Thesis/Dissertation
    Date
    2015
    Author
    Greener, Judith Robin
    Advisor
    Bass, Sarah Bauerle
    Committee member
    Lepore, Stephen J.
    Davey, Adam
    Daly, Mary B.
    Department
    Public Health
    Subject
    Behavioral Sciences
    Health Sciences
    Communication
    Breast Cancer
    Contralateral Prophylactic Mastectomy
    Decision Making
    Perceptual Mapping
    Permanent link to this record
    http://hdl.handle.net/20.500.12613/2951
    
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    DOI
    http://dx.doi.org/10.34944/dspace/2933
    Abstract
    The rate at which women choose mastectomy has grown dramatically, and of particular note is the increase in contralateral prophylactic mastectomy (CPM). For women with no history of breast cancer or genetic risk, CPM represents a treatment decision that does not offer better long-term outcomes than the decision not to remove a healthy breast and may be associated with increased surgical risk and interventions, increased cost to the healthcare system, and potential adverse psycho-social outcomes. To better understand the decision making process regarding the election of CPM among women with early stage unilateral breast cancer, with no family history or genetic risk, a three-phase exploratory study was conducted. Qualitative in-depth interviews were conducted with healthcare providers who have close interaction with women during the decision making process (N=3) and patients who made a surgical decision about breast cancer treatment within the past three years (N=11). These two phases informed the design of the quantitative internet survey, conducted among women diagnosed with early stage breast cancer in the process of making a surgical decision (N=336). The survey design was also guided by an existing model for treatment decision making which uses a social ecological framework (Revenson & Pranikoff, 2005). In addition to descriptive analyses, perceptual mapping was utilized to understand patients’ conceptualizations of the relative importance of factors considered during the decision making process, and AdSAM® was used to gauge emotional response. Results suggest that women more likely to elect CPM demonstrate an emotional response to a generalized fear of cancer, along with the need to take control of their situation. In addition, retrospective interviews emphasized somewhat different reasons for electing CPM, highlighting the importance of prospective research in studying the decision making process.
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