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Title: Risk-reducing mastectomy perceptions and decision-making among women at high risk of breast cancer
Author: Shaw Nunez, E.
ISNI:       0000 0004 6496 4247
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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This thesis consists of two chapters, a systematic review and an empirical paper, supplemented with additional information and supporting documents that can be found in the appendices. Both chapters are intended for publication and thus have been written in the style of the identified journal for submission, The European Journal of Cancer Care. The author guidelines followed can be found in Appendix A. Recent advancements in genetic testing have led to more accurate estimations of some individuals' risks of developing breast cancer. A number of options are available for women at increased risk of this illness, defined as those who have a 30% lifetime risk of developing breast cancer due to their family history and/or to deleterious genetic mutations (National Institute of Health and Clinical Excellence, 2013). These alternatives are close surveillance using screening procedures, risk-reducing medication also known as chemoprevention, and surgical options. The latter includes risk-reducing mastectomy (RRM), the surgical removal of breast tissue with or without immediate or delayed reconstruction. There has been a notable increase in requests for RRM in recent years (Evans et al., 2015), and the knowledgebase regarding patients' decision-making continues to grow. In the United Kingdom, efforts have been made to establish guidelines for professionals working with patients who are considering RRM (British Psychological Society's Division of Clinical Psychology Faculty for Oncology and Palliative Care, 2017). Given that the choice of undergoing RRM can be complex and influenced by wideranging personal and societal factors, Chapter One aims to synthesise both qualitative and quantitative literature that explored women's views of risk-reducing breast surgery and of factors affecting their decision-making regarding this procedure, specifically when they are considering at least one other risk management alternative due to being at familial high risk of developing breast cancer. The findings of the literature review echo research within the wider literature acknowledging the multiple factors influencing patients' reasons for requesting RRM, such as risk perceptions or estimations (Fielden, Brown, Saini, Beesley, & Salmon, 2017) and psychological factors such as fear and worry about cancer (Beesley, Holcombe, Brown, & Salmon, 2013). In light of the above, Chapter Two aimed to gain a further understanding of patient's views about RRM and of how they reach their decision to opt for this procedure. Using a qualitative methodology, this study contributes to the existing research by furthering our understanding of these issues in the context of decision-making theory, highlighting that patients who are at high risk of breast cancer might reach RRM decisions heuristically.
Supervisor: Brown, S. L. ; Salmon, P. ; Fairburn, L. Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral