title: Risk-reducing salpingectomy with delayed oophorectomy in BRCA1/2 mutation carriers: patients' and professionals' perspectives.
abstract: OBJECTIVE
  To identify influencing factors of BRCA1/2 mutation carriers and their professionals for risk-reducing salpingectomy (RRS) with delayed oophorectomy (RRO) as a substitute for risk-reducing salpingo-oophorectomy (RRSO) and for study participation on this concept.
  
  
  METHODS
  A qualitative study was performed by four focus group interviews with 39 BRCA1/2 mutation carriers and semi-structured in-depth interviews with 23 professionals in the field of hereditary cancer. We used a theoretical framework of determinants of innovation within healthcare organizations to classify influencing factors (barriers and facilitators).
  
  
  RESULTS
  Among BRCA1/2 mutation carriers, main barriers for RRS with delayed RRO were seriousness of ovarian cancer, family history, and previous breast cancer. Among professionals, delay of risk-reducing effect of oophorectomy on breast cancer risk and a second operation were recognized as main barriers. Both BRCA1/2 mutation carriers and professionals found uncertainty about the effect of RRS with delayed RRO and ease of the decision to undergo RRSO important barriers. The main facilitator mentioned by both was longer maintenance of ovarian function thereby delaying negative effects of early surgical menopause. For study participation, BRCA1/2 mutation carriers mentioned a randomized study design as the main barrier, whereas professionals identified two facilitators, namely willingness of BRCA1/2 mutation carriers for study participation and uniform counseling. Furthermore, most BRCA1/2 mutation carriers and professionals were willing to consider participation in a future non-randomized study.
  
  
  CONCLUSIONS
  We identified several barriers and facilitators for RRS with delayed RRO, and for study participation which can be addressed to optimize the design and implementation of a non-randomized study.
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Marieke.Arts-deJong@radboudumc.nl.
authors.forename: Marieke
authors.initials: M
authors.lastname: Arts-de Jong
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marline G
authors.initials: MG
authors.lastname: Harmsen
authors.affiliation: Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Nicoline
authors.initials: N
authors.lastname: Hoogerbrugge
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Leon F
authors.initials: LF
authors.lastname: Massuger
authors.affiliation: Department of IQ-Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Rosella P
authors.initials: RP
authors.lastname: Hermens
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Joanne A
authors.initials: JA
authors.lastname: de Hullu
mesh_terms: D000328:Adult; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D058994:Salpingectomy / Q000379:methods*
keywords: BRCA mutation; Ovarian cancer; Patients' perspectives; Professionals' perspectives; Risk-reducing strategy