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Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests

Brown, Stephen L.; Whiting, Demian; Fielden, Hannah G.; Saini, Pooja; Beesley, Helen; Holcombe, Christopher; Holcombe, Susan; Greenhalgh, Lyn; Fairburn, Louise; Salmon, Peter


Stephen L. Brown

Hannah G. Fielden

Pooja Saini

Helen Beesley

Christopher Holcombe

Susan Holcombe

Lyn Greenhalgh

Louise Fairburn

Peter Salmon


Sudeep Gupta


Objective: Contemporary approaches to medical decision-making advise that clinicians should respect patients' decisions. However, patients' decisions are often shaped by heuristics, such as being guided by emotion, rather than by objective risk and benefit. Risk-reducing mastectomy (RRM) decisions focus this dilemma sharply. RRM reduces breast cancer (BC) risk, but is invasive and can have iatrogenic consequences. Previous evidence suggests that emotion guides patients' decision-making about RRM. We interviewed patients to better understand how they made decisions about RRM, using findings to consider how clinicians could ethically respond to their decisions. Methods: Qualitative face-to-face interviews with 34 patients listed for RRM surgery and two who had decided against RRM. Results: Patients generally did not use objective risk estimates or, indeed, consider risks and benefits of RRM. Instead emotions guided their decisions: they chose RRM because they feared BC and wanted to do 'all they could' to prevent it. Most therefore perceived RRM to be the 'obvious' option and made the decision easily. However, many recounted extensive post-decisional deliberation, generally directed towards justifying the original decision. A few patients deliberated before the decision because fears of surgery counterbalanced those of BC. Conclusion: Patients seeking RRM were motivated by fear of BC, and the need to avoid potential regret for not doing all they could to prevent it. We suggest that choices such as that for RRM, which are made emotionally, can be respected as autonomous decisions, provided patients have considered risks and benefits. Drawing on psychological theory about how people do make decisions, as well as normative views of how they should, we propose that practitioners can guide consideration of risks and benefits even, where necessary, after patients have opted for surgery. This model of practice could be extended to other medical decisions that are influenced by patients' emotions.


Brown, S. L., Whiting, D., Fielden, H. G., Saini, P., Beesley, H., Holcombe, C., …Salmon, P. (2017). Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests. PLoS ONE, 12(5), e0178392.

Journal Article Type Article
Acceptance Date May 14, 2017
Online Publication Date May 26, 2017
Publication Date May 26, 2017
Deposit Date Jul 25, 2017
Publicly Available Date Jul 25, 2017
Journal PLoS one
Print ISSN 1932-6203
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 12
Issue 5
Article Number ARTN e0178392
Pages e0178392
Keywords General Biochemistry, Genetics and Molecular Biology; General Agricultural and Biological Sciences; General Medicine
Public URL
Publisher URL
Additional Information This is a copy of an open access article published in PLoS one, v.12 issue 5.


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Copyright Statement
© 2017 Brown et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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