Decision making factors of BRCA positive women and their decision to have a prophylactic mastectomy
Approximately 5% to 10% of breast cancer cases will be a result of a mutation in the breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). An individual with a mutation in either of these genes has a greater probability of malignant transformation and the subsequent development of breast cancer. Once a woman is genetically tested and discovers she has inherited a BRCA mutation, she is confronted with a number of challenging decisions. One of the most distressing decisions is whether or not to pursue a prophylactic bilateral mastectomy to decrease her breast cancer risk. The purpose of this study was to explore the decision-making processes of BRCA positive women, 50 years of age or younger, and their decision to elect to have a prophylactic bilateral mastectomy.
Seventeen BRCA positive women were interviewed in order to understand the decision-making process in electing to have a prophylactic mastectomy. Grounded theory methodology using Strauss and Corbin’s method with Feminist epistemology as the philosophical framework was utilized. Semi-structured interviews were conducted. Data analysis was performed utilizing open, axial, and selective coding.
Three major categories or decision-making processes evolved: influential others, knowledge and awareness, and ownership of body. The core category was identified as taking charge. Considering the timing of their surgery in view of significant life events or stages was also essential to taking charge. The collective experience eventually progresses to situated decision-making among BRCA positive women. The concept of timing and situated decision-making among BRCA positive women seemed to vary or fluctuate depending on the unique experiences of each individual.
The theory recognizes that although fear and anxiety developed in these women as a result of being BRCA positive, they took proactive measures and positively changed their mindset in order to help alleviate their concerns. The collective experience of all these processes provided these women the necessary knowledge and information needed in order to make an informed decision based on their current life situation progressing to the Situated Decision-making Among BRCA Women Grounded Theory.