Patient-driven decisions and perceptions of the 'safest possible choice': insights from patient-provider conversations about how some breast cancer patients choose contralateral prophylactic mastectomy.

Autor:	Padamsee TJ; Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA.; James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA., Phommasathit C; James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA., Swinehart-Hord P; Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA., Chettri S; Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA., Clevenger K; James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA., Rayo MF; Department of Integrated Systems Engineering, The Ohio State University College of Engineering, Columbus, Ohio, USA., Agnese DM; James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA., Bazan JG; Department of Radiation Oncology, City of Hope, Duarte, California, USA., Jones N; Surgical Oncology, Ohio Health, Columbus, Ohio, USA., Lee CN; Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA.; James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA.; Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Jazyk:	angličtina
Zdroj:	Psychology & health [Psychol Health] 2023 Dec 03, pp. 1-25. Date of Electronic Publication: 2023 Dec 03.
DOI:	10.1080/08870446.2023.2290170
Abstrakt:	Objective: Observe patient-clinician communication to gain insight about the reasons underlying the choice of patients with unilateral breast cancer to undergo contralateral prophylactic mastectomy (CPM), despite lack of survival benefit, risk of harms, and cautions expressed by surgical guidelines and clinicians. Methods & Measures: WORDS is a prospective study that explored patient-clinician communication and patient decision making. Participants recorded clinical visits through a downloadable mobile application. We analyzed 44 recordings from 22 patients: 9 who chose CPM, 8 who considered CPM but decided against it, and 5 who never considered CPM. We used abductive analysis combined with constructivist grounded theory methods. Results: Decisions to undergo CPM are patient-driven and motivated by perceptions that CPM is the most aggressive, and therefore safest, treatment option available. These decisions are shaped not primarily by the content of conversations with clinicians, but by the history of cancer in patients' families, their own first-hand experiences with cancers among loved ones, fear for their children, and anxiety about cancer recurrence. Conclusion: The perception that CPM is the safest, most aggressive option strongly influences patients, despite scientific evidence to the contrary. Future efforts to address high CPM rates should focus on patient-driven decision making and cancer-related fears.
Databáze:	MEDLINE
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