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Decision-making and breast reconstruction
To date, a paucity of research has examined the process by which women decide whether or not to undergo breast reconstruction. Exceptionally, Reaby (1998a, 1999) classified the decision-making style used by 95 women who decided for (n = 31) or against (n=64) reconstruction according to the degree of conflict, information-seeking, deliberation and regret experienced. Most women electing not to have reconstructive surgery were classified as `sideliners' -- choosing the alternative that was the simplest to implement. These women made rapid, conflict-free decisions but were prone to regret at a later date. None of the reconstruction patients made their decision in this way, tending instead to demonstrate the `contented' pattern -- having a strong preference for reconstruction based on individual personal needs and showing little regret. This pattern was also used by 12% of the women electing not to undergo reconstructive surgery. More than 30% of the women who underwent reconstruction and 12% of those having mastectomy alone were classified as `shifters' -- vacillating between possible alternatives and relying upon other people to make the decision for them. One woman used the `panic-stricken' approach, being too distressed to process information and choosing reconstruction without any recollection of doing so.
None of the women in Reaby's study had actively sought out information and weighed up the available alternatives in a rational, methodical and `enlightened' approach deemed unlikely to result in postdecisional regret. It is unclear whether the four women who underwent a delayed procedure reported decision-making processes or levels of postdecisional regret comparable with those reported by immediate reconstruction patients. Furthermore, the retrospective interviews did not investigate the decision-making process whilst it was taking place.
Many women facing the option of breast reconstruction choose not to make such decisions themselves, preferring to pass these decisions back to health professionals (Anderson & Kaczmarek 1996). If breast reconstruction is to be offered to all women then health professionals (including breast care nurses) need to be able to offer psychological support and to help women to make informed choices. The necessity to support women facing decisions about their primary treatment for breast cancer has been widely acknowledged (Fallowfield et al. 1994) and it is reasonable to suggest that this support should extend to decisions concerning reconstructive surgery (Rosenqvist et al. 1996).
Psychological support for women considering breast reconstruction
In aiming to clarify the role of health professionals in this area, Winder and Winder (1985) and Reaby (1998a, 1998b) have stressed that women considering reconstruction should have access to a trained professional who provides basic, clear, relevant, up-to-date information; helps them prepare for medical consultations; provides support; encourages the involvement of family and friends; ensures women have sufficient time to make their choice and is aware of the psychological issues around breast loss and body image disturbance.
It is also important to discuss the nature and possibility of surgical complications with women contemplating breast reconstruction. Whilst any kind of surgical procedure is an anxiety-provoking and stressful event (Johnston 1988), women with high expectations and hopes pinned upon the outcome of reconstructive surgery may be especially vulnerable to severe distress and disappointment if complications occur, thereby compounding the psychological trauma of mastectomy. However, Borah et al. (1999) report that the possibility of such psychological complications is rarely discussed.
- Harcourt, Rumsey; Psychological aspects of breast reconstruction: a review of the literature; Journal of Advanced Nursing; Aug 2001; Vol. 35; Issue 4.
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