Sun-Young Park, Youlim Kim, Maria C Katapodi, Hye Jin Chun, Dohee Ahn, Mijin An, So-Youn Jung
{"title":"韩国对侧预防性乳房切除术决策的挑战：遗传性乳腺癌患者和提供者视角的定性研究。","authors":"Sun-Young Park, Youlim Kim, Maria C Katapodi, Hye Jin Chun, Dohee Ahn, Mijin An, So-Youn Jung","doi":"10.1002/pon.70266","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The uptake of contralateral prophylactic mastectomy (CPM) has increased among patients with breast cancer and BRCA-pathogenic variants. However, CPM decision-making remains complex, involving various risks and benefits, and requiring comprehensive patient support. This study explored patients' and healthcare providers' (HCPs') perspectives during CPM decision-making in the Korean healthcare context.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 17 patients with breast cancer and BRCA pathogenic variants and 10 HCPs (7 breast surgeons, 3 advanced practice nurses) between August and September 2024. A reflexive thematic analysis was conducted based on Charles's decision-making model.</p><p><strong>Results: </strong>Three themes emerged across decision-making stages for both patients and HCPs. Patients needed more information and guidance during the information exchange phase. In contrast, HCPs hesitated to guide decision-making due to limited CPM evidence, negative perceptions of CPM, and time constraints. During the deliberation phase, patients required more counseling and trust-building with HCPs. However, HCPs faced resource constraints (time, staff, space), hindering these supports. In the decision-making phase, patients' preferences varied, ranging from autonomous to physician-led decisions, whereas HCPs maintained neutrality, recognizing patients as primary decision-makers. These opposing positions create a mismatch in decision-making role expectations between patients and HCPs.</p><p><strong>Conclusion: </strong>This study highlights gaps and challenges in information, support, and decision-making roles between patients and HCPs. A shared decision-making approach, backed by insurance reimbursement, could help bridge these gaps. Providing additional resources- counseling time, staffing, space, and decision aids-may improve patient-centered decision-making in the Korean healthcare context.</p>","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"34 9","pages":"e70266"},"PeriodicalIF":3.5000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Challenges in Decision-Making for Contralateral Prophylactic Mastectomy in Korea: A Qualitative Study of Perspectives of Patients With Hereditary Breast Cancer and Providers.\",\"authors\":\"Sun-Young Park, Youlim Kim, Maria C Katapodi, Hye Jin Chun, Dohee Ahn, Mijin An, So-Youn Jung\",\"doi\":\"10.1002/pon.70266\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The uptake of contralateral prophylactic mastectomy (CPM) has increased among patients with breast cancer and BRCA-pathogenic variants. However, CPM decision-making remains complex, involving various risks and benefits, and requiring comprehensive patient support. This study explored patients' and healthcare providers' (HCPs') perspectives during CPM decision-making in the Korean healthcare context.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 17 patients with breast cancer and BRCA pathogenic variants and 10 HCPs (7 breast surgeons, 3 advanced practice nurses) between August and September 2024. A reflexive thematic analysis was conducted based on Charles's decision-making model.</p><p><strong>Results: </strong>Three themes emerged across decision-making stages for both patients and HCPs. Patients needed more information and guidance during the information exchange phase. In contrast, HCPs hesitated to guide decision-making due to limited CPM evidence, negative perceptions of CPM, and time constraints. During the deliberation phase, patients required more counseling and trust-building with HCPs. However, HCPs faced resource constraints (time, staff, space), hindering these supports. In the decision-making phase, patients' preferences varied, ranging from autonomous to physician-led decisions, whereas HCPs maintained neutrality, recognizing patients as primary decision-makers. These opposing positions create a mismatch in decision-making role expectations between patients and HCPs.</p><p><strong>Conclusion: </strong>This study highlights gaps and challenges in information, support, and decision-making roles between patients and HCPs. A shared decision-making approach, backed by insurance reimbursement, could help bridge these gaps. Providing additional resources- counseling time, staffing, space, and decision aids-may improve patient-centered decision-making in the Korean healthcare context.</p>\",\"PeriodicalId\":20779,\"journal\":{\"name\":\"Psycho‐Oncology\",\"volume\":\"34 9\",\"pages\":\"e70266\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Psycho‐Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/pon.70266\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Psycho‐Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/pon.70266","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
Challenges in Decision-Making for Contralateral Prophylactic Mastectomy in Korea: A Qualitative Study of Perspectives of Patients With Hereditary Breast Cancer and Providers.
Background: The uptake of contralateral prophylactic mastectomy (CPM) has increased among patients with breast cancer and BRCA-pathogenic variants. However, CPM decision-making remains complex, involving various risks and benefits, and requiring comprehensive patient support. This study explored patients' and healthcare providers' (HCPs') perspectives during CPM decision-making in the Korean healthcare context.
Methods: Semi-structured interviews were conducted with 17 patients with breast cancer and BRCA pathogenic variants and 10 HCPs (7 breast surgeons, 3 advanced practice nurses) between August and September 2024. A reflexive thematic analysis was conducted based on Charles's decision-making model.
Results: Three themes emerged across decision-making stages for both patients and HCPs. Patients needed more information and guidance during the information exchange phase. In contrast, HCPs hesitated to guide decision-making due to limited CPM evidence, negative perceptions of CPM, and time constraints. During the deliberation phase, patients required more counseling and trust-building with HCPs. However, HCPs faced resource constraints (time, staff, space), hindering these supports. In the decision-making phase, patients' preferences varied, ranging from autonomous to physician-led decisions, whereas HCPs maintained neutrality, recognizing patients as primary decision-makers. These opposing positions create a mismatch in decision-making role expectations between patients and HCPs.
Conclusion: This study highlights gaps and challenges in information, support, and decision-making roles between patients and HCPs. A shared decision-making approach, backed by insurance reimbursement, could help bridge these gaps. Providing additional resources- counseling time, staffing, space, and decision aids-may improve patient-centered decision-making in the Korean healthcare context.
期刊介绍：
Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology.
This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues.
Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.
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