How do women at increased breast cancer risk perceive and decide between risks of cancer and risk-reducing treatments? A synthesis of qualitative research.
How do women at increased breast cancer risk perceive and decide between risks of cancer and risk-reducing treatments? A synthesis of qualitative research.
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DOI：
10.1002/pon.4349
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发表时间：
2017-09
期刊：
影响因子：
3.6
通讯作者：
Salmon P
中科院分区：
文献类型：
--
作者：
Fielden HG;Brown SL;Saini P;Beesley H;Salmon P
降低风险的程序可以提供给癌症风险增加的人，但许多程序可能具有医源性影响。因此，人们需要在决策中权衡与癌症和风险降低程序相关的风险。通过回顾乳腺癌（BC）风险降低的相关文献，我们的目的是了解女性在相对较高的风险BC如何看待自己的风险，以及他们的风险认知如何影响他们的风险降低的决定。综合15项定性研究，这些研究来自对SCOPUS、Web of Knowledge、PsychINFO和Medline电子数据库的系统性检索（开始至2015年6月）。女性不会从概率的角度考虑风险。相反，他们将自己分配到广泛的风险类别，通常受到自己或家庭BC经历的影响。在决定风险降低程序时，一些妇女报告称权衡了风险和益处，但论文没有描述她们是如何做到的。然而，对于许多女性来说，减少对BC的强烈担忧的压倒一切的愿望导致她们在没有这种考虑的情况下选择积极的降低风险的程序。推理分类是风险认知的一个基本方面，我们认为，可以鼓励患者通过与临床医生的互动，对自己的风险进行更细致入微和准确的分类。需要基于经验的伦理反思来确定是否以及何时适合提供风险降低程序以减轻担忧。
Risk‐reducing procedures can be offered to people at increased cancer risk, but many procedures can have iatrogenic effects. People therefore need to weigh risks associated with both cancer and the risk‐reduction procedure in their decisions. By reviewing relevant literature on breast cancer (BC) risk reduction, we aimed to understand how women at relatively high risk of BC perceive their risk and how their risk perceptions influence their decisions about risk reduction. Synthesis of 15 qualitative studies obtained from systematic searches of SCOPUS, Web of Knowledge, PsychINFO, and Medline electronic databases (inception‐June 2015). Women did not think about risk probabilistically. Instead, they allocated themselves to broad risk categories, typically influenced by their own or familial experiences of BC. In deciding about risk‐reduction procedures, some women reported weighing the risks and benefits, but papers did not describe how they did so. For many women, however, an overriding wish to reduce intense worry about BC led them to choose aggressive risk‐reducing procedures without such deliberation. Reasoning that categorisation is a fundamental aspect of risk perception, we argue that patients can be encouraged to develop more nuanced and accurate categorisations of their own risk through their interactions with clinicians. Empirically‐based ethical reflection is required to determine whether and when it is appropriate to provide risk‐reduction procedures to alleviate worry.
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影响因子：
3.2
作者：
Howard, A. Fuchsia;Balneaves, Lynda G.;Rodney, Patricia
通讯作者：
Rodney, Patricia
影响因子：
4.2
作者：
Bao, Ting;Prowell, Tatiana;Stearns, Vered
通讯作者：
Stearns, Vered
影响因子：
2.1
作者：
Domchek, Susan M.;Rebbeck, Timothy R.
通讯作者：
Rebbeck, Timothy R.
影响因子：
3.2
作者：
Elwyn, Glyn;Miron-Shatz, Talya
通讯作者：
Miron-Shatz, Talya
影响因子：
10.3
作者：
Heemskerk-Gerritsen, B. A. M.;Seynaeve, C.;Hooning, M. J.
通讯作者：
Hooning, M. J.