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How do women at increased breast cancer risk perceive and decide between risks of cancer and risk‐reducing treatments? A synthesis of qualitative research
Author(s) -
Fielden Hannah G.,
Brown Stephen L.,
Saini Pooja,
Beesley Helen,
Salmon Peter
Publication year - 2017
Publication title -
psycho‐oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.41
H-Index - 137
eISSN - 1099-1611
pISSN - 1057-9249
DOI - 10.1002/pon.4349
Subject(s) - worry , risk perception , risk assessment , scopus , breast cancer , psychology , medline , deliberation , qualitative research , risk analysis (engineering) , medicine , perception , cancer , computer science , psychiatry , political science , anxiety , computer security , politics , law , social science , neuroscience , sociology
Abstract Objective Risk‐reducing procedures can be offered to people at increased cancer risk, but many procedures can have iatrogenic effects. People therefore need to weigh risks associated with both cancer and the risk‐reduction procedure in their decisions. By reviewing relevant literature on breast cancer (BC) risk reduction, we aimed to understand how women at relatively high risk of BC perceive their risk and how their risk perceptions influence their decisions about risk reduction. Methods Synthesis of 15 qualitative studies obtained from systematic searches of SCOPUS, Web of Knowledge, PsychINFO, and Medline electronic databases (inception‐June 2015). Results Women did not think about risk probabilistically. Instead, they allocated themselves to broad risk categories, typically influenced by their own or familial experiences of BC. In deciding about risk‐reduction procedures, some women reported weighing the risks and benefits, but papers did not describe how they did so. For many women, however, an overriding wish to reduce intense worry about BC led them to choose aggressive risk‐reducing procedures without such deliberation. Conclusions Reasoning that categorisation is a fundamental aspect of risk perception, we argue that patients can be encouraged to develop more nuanced and accurate categorisations of their own risk through their interactions with clinicians. Empirically‐based ethical reflection is required to determine whether and when it is appropriate to provide risk‐reduction procedures to alleviate worry.