Highlights
- •CPM decision-making is influenced by women's beliefs about CPM and their social environment.
- •Avoidance of negative affect and difficulties linked to not having surgery impact on CPM intentions.
- •The results provide strong support for the development of a decision-aid for CPM decision making.
Abstract
Purpose
Most women with unilateral breast cancer (BC) without BRCA1/2 gene mutations are at low risk of contralateral breast cancer (CBC). One CBC risk-management
option is contralateral prophylactic mastectomy (CPM). While there is no evidence
that CPM increases life-expectancy, its uptake is increasing. This study aimed to
assess the validity of an extended social-cognition model, the Theory of Planned Behaviour
(TPB), in predicting women's intentions to undergo CPM.
Method
Four hundred women previously treated for BC completed an online survey exploring
demographic and disease factors, attitude, subjective norm, perceived behavioural
control, anticipated regret, uncertainty avoidance, self-efficacy to not have CPM and intentions to undergo CPM in a common hypothetical decision-making scenario.
Results
The TPB uniquely explained 25.7% of intention variance. Greater anticipated regret,
uncertainty avoidance and lower self-efficacy to cope with not having CPM were associated with stronger CPM intentions, explaining an additional
7.7%, 10.6% and 2.9% respectively, of variance over and above the TPB. Women who had
undergone CPM, had not attended university, and had children reported stronger CPM
intentions.
Conclusions
A holistic understanding of CPM decision-making appears to require consideration beyond
CBC risk, demographics and disease characteristics, exploring women's expectations
about CPM outcomes, others' opinions, and avoidance of emotionality and difficulties
associated with not undergoing surgery. This study provides a theoretical basis from which the complexity
of CPM decision-making may be understood, and from which resources for patients and
treating staff may be developed to support women's informed decision-making aligning
with their personal values.
Keywords
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Article info
Publication history
Published online: February 02, 2016
Accepted:
December 7,
2015
Received in revised form:
November 14,
2015
Received:
August 24,
2015
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
