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The development of a template for psychological assessment of women considering risk‐reducing or contralateral prophylactic mastectomy: A national Delphi consensus study
Author(s) -
Braude Lucy,
Kirsten Laura,
Gilchrist Jemma,
Juraskova Ilona
Publication year - 2018
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.4830
Subject(s) - delphi method , anxiety , medicine , delphi , breast cancer , population , family medicine , clinical psychology , psychiatry , cancer , computer science , environmental health , artificial intelligence , operating system
Objective Risk‐reducing mastectomies (RRM) and contralateral prophylactic mastectomies (CPM) are increasingly prevalent strategies to reduce breast cancer risk. Given the associated physical and emotional challenges, presurgical psychological assessment is frequently recommended for this population, yet limited research exists to guide this. This study aimed to reach a consensus on the most relevant content and format of a psychological consultation prior to RRM/CPM. Methods A modified two‐round online Delphi study was conducted Australia‐wide. Expert participants (n = 25), including psychologists, surgeons, nurses, oncologists, genetic specialists, and researchers completed a round‐one survey, informed by a literature review, previous qualitative study and expert clinicians' input. This required participants to rate their agreement with 36 statements regarding potential content of a psychological consultation and provide feedback on format/structure. A round‐two survey comprised items that had not reached consensus and six new items suggested by participants. Parameters for statement consensus were set a priori at >75% agreement. Results Expert participants indicated agreement with the majority of statements (39/42, 92.8%), endorsing that the assessment should include (1) patient understanding of the RRM/CPM procedure/cancer risk, (2) potential physical/emotional impact of surgery, (3) informed decision‐making, and (4) past/current psychological issues (anxiety and body image). A provisional assessment template and user manual is provided. Conclusions This research culminated in a consensus‐based template to guide psychological assessment of women considering RRM/CPM. This enables health professionals to assess suitability for surgery and preempt challenges within a standardised framework. Future evaluation of the acceptability and effectiveness of the template in clinical settings is warranted.