Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests
| Autor: | Pooja Saini, Stephen L. Brown, Christopher Holcombe, Peter Salmon, Louise Fairburn, Lyn Greenhalgh, Demian Whiting, Susan Holcombe, Helen Beesley, Hannah G. Fielden |
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| Přispěvatelé: | Gupta, S |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Risk reducing mastectomy
Medical Doctors Health Care Providers Emotions lcsh:Medicine Social Sciences 0302 clinical medicine Cognition Sociology Medicine and Health Sciences Psychology 030212 general & internal medicine Reproductive System Procedures lcsh:Science Mastectomy media_common Multidisciplinary Schools Fear 3. Good health Professions 030220 oncology & carcinogenesis Research Article medicine.medical_specialty media_common.quotation_subject Decision Making MEDLINE Surgical and Invasive Medical Procedures Breast Neoplasms Education 03 medical and health sciences Nursing Physicians medicine Genetics Humans Genetic Predisposition to Disease Patient participation Surgeons Surgical Excision business.industry lcsh:R fungi Cognitive Psychology Biology and Life Sciences Regret Deliberation Surgery Dilemma Health Care People and Places Mutation Normative Cognitive Science lcsh:Q Population Groupings Patient Participation Heuristics business RD Neuroscience |
| Zdroj: | PLoS ONE PLoS ONE, Vol 12, Iss 5, p e0178392 (2017) |
| ISSN: | 1932-6203 |
| Popis: | Objective\ud 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.\ud Methods\ud Qualitative face-to-face interviews with 34 patients listed for RRM surgery and two who had decided against RRM.\ud Results\ud 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.\ud Conclusion\ud 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. |
| Databáze: | OpenAIRE |
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