Patient and surgeon decision-making in risk-reducing mastectomy
Research type
Research Study
Full title
Patient and surgeon decision-making in risk-reducing mastectomy: an ethical and empirical analysis
IRAS ID
124656
Contact name
Stephen L Brown
Contact email
Research summary
Risk Reducing Mastectomy (RRM) involves the removal of healthy ductal breast tissue to prevent breast cancer. Contralateral RRM (CRRM) is the removal of tissue in the opposite breast in patients who have experienced cancer. Bilateral RRM (BRRM) is the removal of tissue in the opposite breast to that already removed during treatment mastectomy. Women’s decisions can be difficult. The risks of adverse medical and psychological consequences should be balanced against risk reduction benefits.
Patient preferences for CRRM may be influenced by distress caused by vulnerability to cancer rather than deliberations about risk. Women often assertively request CRRM. Surgeons rarely discuss objective risk with with women but perform CRRM. Thus, the key determinant of CRRM decision-making appears to be distress rather than risk. This might lead to sub-optimal decision-making and inequity in care.
Our understanding of the processes by which patients and practitioners develop preferences and how they jointly reach decisions is insufficient to assess the clinical and ethical implications of this. It is unwise to assume that responding to distress is discordant with ’good’ decision-making, and RRM surgery might bring psychological benefits to patients irrespective of whether risk is reduced. Even if distress is a poor basis for decision-making, there is insufficient evidence to indicate effective and ethical ways to address this problem.
Specific aims are:
1. To identify the factors that women consider when they form CRRM and BRRM preferences.
2. To understand how surgeons respond to these preferences.
3. To understand how patients’ and surgeons’ final decisions are negotiated.
4. To interpret these findings in relation to current thinking in medical decision-making and ethics.REC name
North West - Liverpool Central Research Ethics Committee
REC reference
13/NW/0421
Date of REC Opinion
3 Jul 2013
REC opinion
Favourable Opinion