Development of a patient decision aid (DA) for women with early stage breast cancer considering contralateral prophylactic mastectomy (CPM)
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Type
ThesisThesis type
Masters by ResearchAuthor/s
Ager, Brittany JaneAbstract
Women with a history of breast cancer face an increased risk of developing cancer in the future. Risk of the initial cancer spreading to other parts of the body such as the brain, liver, bones or lung (referred to as metastatic or secondary breast cancer) poses the greatest risk ...
See moreWomen with a history of breast cancer face an increased risk of developing cancer in the future. Risk of the initial cancer spreading to other parts of the body such as the brain, liver, bones or lung (referred to as metastatic or secondary breast cancer) poses the greatest risk to women as metastases are considered ‘incurable’ with treatment aiming to manage symptoms rather than cure disease. Risk of developing a new breast cancer in the (initially) unaffected breast (referred to as ‘contralateral breast cancer’; CBC) is low for most women with early stage breast cancer and unlike metastatic cancer, is often identified early enough for treatment to be successful. Rates of CBC have also been decreasing due to the widespread implementation of additional or ‘adjuvant’ therapies (such as chemotherapy and hormone therapy) which reduce the already low risk of CBC. In recent years however, rates of surgery to remove the unaffected or ‘contralateral’ breast (referred to as contralateral prophylactic mastectomy; CPM) have increased. Although CPM results in the greatest risk reduction for CBC, it does not influence risk of the first cancer spreading and has therefore not been associated with extended survival for most women. Increasing rates with limited clinical gain suggests that women may not be making informed decisions about CPM. Decision aids are increasingly being used to facilitate informed decision making when the treatment decision involves preference-sensitive decisions (where there is no one, best option and the patient has to weigh up benefits and downsides important to them), as is often the case for CPM. This research project therefore aimed to develop a decision aid for women with average risk of CBC considering CPM. Related studies aimed to document the development process, including patient involvement, consistent with the International Patient Decision Aid Standards (IPDAS) and application of the Ottawa Decision Support Framework.
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See moreWomen with a history of breast cancer face an increased risk of developing cancer in the future. Risk of the initial cancer spreading to other parts of the body such as the brain, liver, bones or lung (referred to as metastatic or secondary breast cancer) poses the greatest risk to women as metastases are considered ‘incurable’ with treatment aiming to manage symptoms rather than cure disease. Risk of developing a new breast cancer in the (initially) unaffected breast (referred to as ‘contralateral breast cancer’; CBC) is low for most women with early stage breast cancer and unlike metastatic cancer, is often identified early enough for treatment to be successful. Rates of CBC have also been decreasing due to the widespread implementation of additional or ‘adjuvant’ therapies (such as chemotherapy and hormone therapy) which reduce the already low risk of CBC. In recent years however, rates of surgery to remove the unaffected or ‘contralateral’ breast (referred to as contralateral prophylactic mastectomy; CPM) have increased. Although CPM results in the greatest risk reduction for CBC, it does not influence risk of the first cancer spreading and has therefore not been associated with extended survival for most women. Increasing rates with limited clinical gain suggests that women may not be making informed decisions about CPM. Decision aids are increasingly being used to facilitate informed decision making when the treatment decision involves preference-sensitive decisions (where there is no one, best option and the patient has to weigh up benefits and downsides important to them), as is often the case for CPM. This research project therefore aimed to develop a decision aid for women with average risk of CBC considering CPM. Related studies aimed to document the development process, including patient involvement, consistent with the International Patient Decision Aid Standards (IPDAS) and application of the Ottawa Decision Support Framework.
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Date
2017-01-01Licence
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Science, School of PsychologyAwarding institution
The University of SydneyShare