Decision-making regarding risk-reducing options in breast cancer

Fielden, Hannah Decision-making regarding risk-reducing options in breast cancer. Doctor of Clinical Psychology thesis, University of Liverpool.

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Abstract

Breast cancer is the most common cancer in the UK and responsible for the second highest number of cancer deaths in women (Cancer Research UK, 2013). Prognostic developments are making it increasingly possible to identify those at increased risk of the disease and advances in cancer risk reduction strategies aim to reduce women’s risk of developing breast cancer. However, the risk-reducing strategies available to women have different risk-reducing capabilities and some can have negative side effects. Women at increased risk of breast cancer are faced with a series of complex decisions including whether or not to act to reduce their level of risk, along with the risk and benefits of different risk-reducing options. Health decision theories afford a central role for risk perception in the uptake of health protection behaviour. To date, there has been mixed evidence for the role of risk perception in the uptake of breast cancer risk-reducing behaviour. Within the quantitative research paradigm, risk perception is often measured as a quantitative estimate, driven by an assumption that women perceive risk in numerical and dimensional terms. This research tells us very little about the forms in which women represent risk and the influence of these risk representations on choices; possibly explaining why studies often show weak relationships between risk perceptions and behaviour. In an effort to further our understanding of women’s choices in this area, the literature review aimed to synthesise qualitative literature that explored how women at increased risk of breast cancer perceived risk and the role of risk perceptions in decisions regarding risk-reducing strategies. Women deemed to be at a significantly increased risk of breast cancer can choose to undertake risk-reducing mastectomy (RRM), the surgical removal of breast tissue for risk-reducing purposes. This procedure is controversial because of the potential for physical and psychological harm and the mixed evidence regarding the survival benefits. Findings from a case series of women undertaking RRM (Beesley, Holcombe, Brown, & Salmon, 2013) suggest that women were driven to opt for the procedure because of a sense of vulnerability to cancer and desire for cosmesis. These findings call into question the role that risk perception plays in this decision-making process. Conclusions however are limited by the case series design and sparse reflection on the relevance of the findings to theoretical understanding. The empirical study aimed to explore, using in-depth interviews, how women make decisions regarding RRM and to identify implications of the findings for the role of decision support for women considering RRM and for psychological theory.

Item Type:	Thesis (Doctor of Clinical Psychology)
Additional Information:	Date: 2014-11 (completed)
Depositing User:	Symplectic Admin
Date Deposited:	27 Aug 2015 15:35
Last Modified:	17 Dec 2022 01:27
DOI:	10.17638/02008883
URI:	https://livrepository.liverpool.ac.uk/id/eprint/2008883