Challenges in Decision-Making for Contralateral Prophylactic Mastectomy in Korea: A Qualitative Study of Perspectives of Patients With Hereditary Breast Cancer and Providers

초록

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.

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