Preserving the self: the process of decision making about hereditary breast cancer and ovarian cancer risk reduction.
Women who carry BRCA1 or BRCA2 (BRCA1/2) gene mutations have up to an 88% lifetime risk of breast cancer and up to a 65% lifetime risk of ovarian cancer. Strategies to address these risks include cancer screening and risk-reducing surgery (i.e., mastectomy and salpingo-oophorectomy). We conducted a grounded theory study with 22 BRCA1/2 mutation-carrier women to understand how women make decisions about these risk-reducing strategies. Preserving the self was the overarching decision-making process evident in the participants' descriptions. This process was shaped by contextual conditions including the characteristics of health services, the nature of hereditary breast and ovarian cancer risk-reduction decisions, gendered roles, and the women's perceived proximity to cancer. The women engaged in five decision-making styles, and these were characterized by the use of specific decision-making approaches. These findings provide theoretical insights that could inform the provision of decisional support to BRCA1/2 carriers.
Howard
A Fuchsia
AF
School of Population and Public Health, University of British Columbia, Vancouver, Canada. fuchsiahoward@mac.com
Balneaves
Lynda G
LG
Bottorff
Joan L
JL
Rodney
Patricia
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000601:surgery; D003657:Decision Making; D055088:Early Detection of Cancer; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D006801:Humans; D007406:Interview, Psychological; D008408:Mastectomy / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D009154:Mutation; D009386:Neoplastic Syndromes, Hereditary / Q000453:epidemiology*; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000601:surgery; D010052:Ovariectomy; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D016387:Women's Health