title: Decision-making process of women carrying a BRCA1 or BRCA2 mutation who have chosen prophylactic mastectomy.
abstract: OBJECTIVE
  To explore the decision-making process of women with a BRCA1 or BRCA2 gene mutation who have chosen to undergo prophylactic mastectomy.
  
  
  METHODS
  Cross-sectional, qualitative, descriptive design.
  
  
  METHODS
  Participants were recruited from an outpatient cancer prevention center in the oncology and medical genetics departments of a large university-affiliated hospital in Montreal, Quebec, Canada.
  
  
  METHODS
  10 women carrying a BRCA1 or BRCA2 mutation; 8 previously had had a prophylactic mastectomy and 2 were scheduled for surgery at the time of study.
  
  
  METHODS
  Semistructured, in-depth interviews were conducted. Field notes were written and audiotapes were transcribed verbatim. The textual data were coded and analyzed.
  
  
  METHODS
  Decision-making process for prophylactic mastectomy.
  
  
  RESULTS
  Two broad findings emerged. First, several intrapersonal and contextual factors interacted throughout the process to move women either closer to choosing a prophylactic mastectomy or further from the decision. Second, all women reported experiencing a "pivotal point," an emotionally charged event when the decision to have a prophylactic mastectomy became definitive. Pivotal points for patients included either receiving a positive result for a genetic mutation or a breast cancer diagnosis for herself or a family member in the context of positive mutation status.
  
  
  CONCLUSIONS
  Decision making about prophylactic mastectomy was an affective and intuitive process incorporating contexts and their relations rather than a rational, straight-forward process of weighing pros and cons.
  
  
  CONCLUSIONS
  Supportive interventions for women in this population should explicitly address the individual and the inter-relationships of contextual factors that shape decision making about prophylactic mastectomy while recognizing important affective components involved.
authors.affiliation: Cardiac Care Unit, Royal Victoria Hospital, Montreal, Quebec, Canada. megan.mcquirter@mail.mcgill.ca
authors.forename: Megan
authors.initials: M
authors.lastname: McQuirter
authors.forename: Luisa Luciani
authors.initials: LL
authors.lastname: Castiglia
authors.forename: Carmen G
authors.initials: CG
authors.lastname: Loiselle
authors.forename: Nora
authors.initials: N
authors.lastname: Wong
mesh_terms: D000328:Adult; D000339:Affect; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D019545:Intuition; D008016:Life Change Events; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D015404:Nursing Methodology Research; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D011792:Quebec; D012944:Social Support; D011795:Surveys and Questionnaires; D014930:Women / Q000523:psychology