Brown, SL, Whiting, D, Fielden, HG, Saini, P, Beesley, H, Holcombe, C, Holcombe, S, Greenhalgh, L, Fairburn, L and Salmon, P (2017) Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests. PLoS One, 12 (5). ISSN 1932-6203

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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.

Item Type:	Article
Additional Information:	Brown SL, Whiting D, Fielden HG, Saini P, Beesley H, Holcombe C, et al. (2017) Qualitative analysis of how patients decide that they want risk- reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests. PLoS ONE 12(5): e0178392. https://doi.org/10.1371/journal.pone.0178392
Uncontrolled Keywords:	MD Multidisciplinary
Subjects:	R Medicine > RD Surgery
Divisions:	Natural Sciences & Psychology (closed 31 Aug 19)
Publisher:	Public Library of Science
Date Deposited:	12 Mar 2018 09:38
Last Modified:	04 Sep 2021 02:54
DOI or ID number:	10.1371/journal.pone.0178392
Editors:	Gupta, S
URI:	https://researchonline.ljmu.ac.uk/id/eprint/8250

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