Sun-Young Park, Youlim Kim
Strengthening shared decision-making and reducing decisional conflict may minimize CPM-related decision regret. Exploratory findings suggest that preoperative counseling addressing recovery and potential complications may help reduce decision regret, particularly for economically vulnerable patients and those with negative or inconclusive genetic results; however, these findings warrant confirmation in future studies.
PURPOSE: Contralateral prophylactic mastectomy (CPM) is increasingly selected by women at high hereditary risk of breast cancer; however, decision regret remains a concern. This study examined factors influencing CPM-related regret--specifically shared decision-making, decisional conflict, and expectation gaps--and compared outcomes between CPM and non-CPM groups.
METHODS: A cross-sectional online survey of 195 Korean women with unilateral breast cancer at high hereditary risk who had considered CPM was conducted. Decision regret and associated factors were analyzed using independent t tests, chi-square tests, and univariate and multivariate linear regression.
RESULTS: Univariate analyses revealed that greater decision regret was associated with lower affordability for CPM, not undergoing CPM or risk-reducing salpingo-oophorectomy, negative or unknown genetic results, lower shared decision-making, and higher decisional conflict (all ps < 0.05). In multivariate analysis, not undergoing CPM (β = -0.26), lower shared decision-making (β = -0.21), and higher decisional conflict (β = 0.25) remained significant (all ps < 0.05), explaining 26% of the variance. Among CPM recipients (n = 58), larger expectation-experience gaps in pain, reconstruction-related side effects, and recovery were associated with greater regret (all ps < 0.05). Non-CPM patients reported higher decision regret and decisional conflict and lower shared decision-making than CPM patients.
CONCLUSIONS: Strengthening shared decision-making and reducing decisional conflict may minimize CPM-related decision regret. Exploratory findings suggest that preoperative counseling addressing recovery and potential complications may help reduce decision regret, particularly for economically vulnerable patients and those with negative or inconclusive genetic results; however, these findings warrant confirmation in future studies.