title: The decision-making process for breast reconstruction after cancer surgery: Representations of heterosexual couples in long-standing relationships.
abstract: Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. To our knowledge, no research has studied the involvement of the partner in the decision-making process regarding breast reconstruction (BR) after cancer. This study aimed to gain a better understanding of the couples' decision-making process for BR in the cancer context and particularly to investigate the partners' involvement in this process.
  
  
  
  Eighteen participants (nine women who underwent a mastectomy following a first breast cancer and their intimate partners) took part in this study. We conducted semidirective interviews, and a general inductive approach was chosen to capture the representations of the couples.
  
  
  
  The women in the sample were aged between 33 and 66 years (M = 54, SD = 7.5) and their partner between 40 and 76 years (M = 59, SD = 11.6). The duration of their intimate relationship was on average 18 years (SD = 10.4; minimum = 4; maximum = 33). The analysis revealed 11 major themes. The two most salient ones were 'external influence' and 'implication of the partner'. The exploration of the subthemes revealed that the decision-making process is often reported as an interrelated experience by the couples and as a dyadic stressor. The partner's role is depicted as consultative and mostly supportive.
  
  
  
  These results provide new insights on the involvement of the partner in decision-making. Thus, it now seems crucial to develop a prospective study, which will help understand the progression of the decision-making process over time. Statement of contribution What is already known on this subject? Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. Shared decision-making between patients and physicians is now the 'gold standard' in Western Europe and the United States. However, in the context of breast reconstruction (BR) after cancer, factors guiding the decision-making process for BR, especially the potential involvement of the partner, are not very well understood. What does this study add? Provides a qualitative insight on the specific nature of heterosexual couples' representations regarding the decision-making process for breast reconstruction after cancer. Reveals that the decision-making process is often reported as an interrelated experience by the couples and as a dyadic stressor. Underlines the consultative function of partners with women engaged in breast reconstruction.
authors.affiliation: LPPM EA 4452, University of Burgundy, Dijon, France.|Gustave Roussy Hospital, Psycho-Oncology Unit, Villejuif, France.
authors.forename: Léonor
authors.initials: L
authors.lastname: Fasse
authors.affiliation: LPPS EA 4057, University Paris Descartes, IUPDP, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Flahault
authors.affiliation: LPPS EA 4057, University Paris Descartes, IUPDP, Paris, France.
authors.forename: Christel
authors.initials: C
authors.lastname: Vioulac
authors.affiliation: LPPS EA 4057, University Paris Descartes, IUPDP, Paris, France.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Lamore
authors.affiliation: School of Social Sciences & Law, Social Futures Institute, Teesside University, Middlesbrough, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Van Wersch
authors.affiliation: INSERM U1219 'Bordeaux Population Health Research Center' Team 'Psycho-epidemiology of Aging & Chronic Diseases', University of Bordeaux, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Quintard
authors.affiliation: LPPS EA 4057, University Paris Descartes, IUPDP, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Untas
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D003657:Decision Making; D005060:Europe; D005191:Family Characteristics; D005260:Female; D020010:Heterosexuality / Q000523:psychology*; D006801:Humans; D016462:Mammaplasty / Q000523:psychology* / Q000706:statistics & numerical data; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D011446:Prospective Studies; D012747:Sexual Partners; D018454:Spouses / Q000523:psychology* / Q000706:statistics & numerical data; D013995:Time
keywords: cancer; couples; decision-making process; oncology; reconstruction