title: Psychological factors associated with the intention to choose for risk-reducing mastectomy in family cancer clinic attendees.
abstract: OBJECTIVE
  Women seeking counseling because of familial breast cancer occurrence face difficult decisions, such as whether and when to opt for risk-reducing mastectomy (RRM) in case of BRCA1/2 mutation. Only limited research has been done to identify the psychological factors associated with the decision for RRM. This study investigated which psychological factors are related to the intention to choose for RRM.
  
  
  METHODS
  A cohort of 486 cancer-unaffected women with a family history of breast cancer completed the following questionnaires prior to genetic counseling: the Cancer Worry Scale, Positive And Negative Affect Scale, Perceived Personal Control Scale, Hospital Anxiety and Depression Scale and State Anxiety Scale and questions regarding socio-demographic characteristics, family history, risk perception and RRM intention. Multivariate logistic regression was used to analyze the relation between psychological factors and women's intention to choose for RRM.
  
  
  RESULTS
  Factors associated with RRM intention were high positive affect (OR = 1.86, 95%CI = 1.12-3.08), high negative affect (OR = 2.52, 95%CI = 1.44-4.43), high cancer worry (OR = 1.65, 95%CI = 1.00-2.72), high perceived personal control (OR = 3.58, 95%CI = 2.18-5.89), high risk-perception (OR = 1.85, 95%CI = 1.15-2.95) and having children (OR = 2.06, 95%CI = 1.21-3.50).
  
  
  CONCLUSIONS
  Negative and positive affects play an important role in the intention for RRM. Furthermore, perceived personal control over the situation is associated with an intention for RRM. In addition to focusing on accurate risk communication, counseling should pay attention to the influence of perceived control and emotions to facilitate decision-making.
authors.affiliation: Department of Obstetrics & Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: cmg.driel@umcg.nl.
authors.forename: C M G
authors.initials: CMG
authors.lastname: van Driel
authors.affiliation: Department of Genetics, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Oosterwijk
authors.affiliation: Department of Clinical Genetics, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Meijers-Heijboer
authors.affiliation: Department of Clinical Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: van Asperen
authors.affiliation: Department of Medical Psychology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: I A
authors.initials: IA
authors.lastname: Zeijlmans van Emmichoven
authors.affiliation: Department of Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Department of Obstetrics & Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: M J E
authors.initials: MJE
authors.lastname: Mourits
authors.affiliation: Department of Clinical Genetics, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Henneman
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Public and Occupational Health, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: D R M
authors.initials: DRM
authors.lastname: Timmermans
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: G H
authors.initials: GH
authors.lastname: de Bock
mesh_terms: D000328:Adult; D000339:Affect; D001007:Anxiety / Q000523:psychology*; D001943:Breast Neoplasms / Q000517:prevention & control / Q000601:surgery; D002755:Choice Behavior; D015331:Cohort Studies; D003657:Decision Making; D003863:Depression / Q000523:psychology*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling; D061325:Hereditary Breast and Ovarian Cancer Syndrome / Q000235:genetics / Q000523:psychology* / Q000601:surgery; D006801:Humans; D033182:Intention; D016015:Logistic Models; D015999:Multivariate Analysis; D010358:Patient Participation; D010465:Perception; D000072036:Prophylactic Mastectomy / Q000523:psychology*; D012306:Risk; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires
keywords: BRCA1; BRCA2; Counseling; Mastectomy; Prophylactic surgical procedures; Shared decision making