van Driel C M G, Oosterwijk J C, Meijers-Heijboer E J, van Asperen C J, Zeijlmans van Emmichoven I A, de Vries J, Mourits M J E, Henneman L, Timmermans D R M, de Bock G H
Department of Obstetrics & Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Department of Genetics, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Breast. 2016 Dec;30:66-72. doi: 10.1016/j.breast.2016.08.016. Epub 2016 Sep 14.
Women seeking counseling because of familial breast cancer occurrence face difficult decisions, such as whether and when to opt for risk-reducing mastectomy (RRM) in case of BRCA1/2 mutation. Only limited research has been done to identify the psychological factors associated with the decision for RRM. This study investigated which psychological factors are related to the intention to choose for RRM.
MATERIALS & METHODS: A cohort of 486 cancer-unaffected women with a family history of breast cancer completed the following questionnaires prior to genetic counseling: the Cancer Worry Scale, Positive And Negative Affect Scale, Perceived Personal Control Scale, Hospital Anxiety and Depression Scale and State Anxiety Scale and questions regarding socio-demographic characteristics, family history, risk perception and RRM intention. Multivariate logistic regression was used to analyze the relation between psychological factors and women's intention to choose for RRM.
Factors associated with RRM intention were high positive affect (OR = 1.86, 95%CI = 1.12-3.08), high negative affect (OR = 2.52, 95%CI = 1.44-4.43), high cancer worry (OR = 1.65, 95%CI = 1.00-2.72), high perceived personal control (OR = 3.58, 95%CI = 2.18-5.89), high risk-perception (OR = 1.85, 95%CI = 1.15-2.95) and having children (OR = 2.06, 95%CI = 1.21-3.50).
Negative and positive affects play an important role in the intention for RRM. Furthermore, perceived personal control over the situation is associated with an intention for RRM. In addition to focusing on accurate risk communication, counseling should pay attention to the influence of perceived control and emotions to facilitate decision-making.
因家族性乳腺癌发病而寻求咨询的女性面临艰难的决策，例如在BRCA1/2基因突变的情况下是否以及何时选择进行降低风险的乳房切除术（RRM）。目前仅有有限的研究来确定与RRM决策相关的心理因素。本研究调查了哪些心理因素与选择RRM的意愿相关。
一组486名无癌症且有乳腺癌家族史的女性在接受遗传咨询前完成了以下问卷：癌症担忧量表、正负性情绪量表、感知个人控制量表、医院焦虑抑郁量表和状态焦虑量表，以及关于社会人口学特征、家族史、风险感知和RRM意愿的问题。采用多因素逻辑回归分析心理因素与女性选择RRM意愿之间的关系。
与RRM意愿相关的因素包括高积极情绪（OR = 1.86，95%CI = 1.12 - 3.08）、高消极情绪（OR = 2.52，95%CI = 1.44 - 4.43）、高癌症担忧（OR = 1.65，95%CI = 1.00 - 2.72）、高感知个人控制（OR = 3.58，95%CI = 2.18 - 5.89）、高风险感知（OR = 1.85，95%CI = 1.15 - 2.95）和育有子女（OR = 2.06，95%CI = 1.21 - 3.50）。
消极和积极情绪在RRM意愿中起重要作用。此外，对情况的感知个人控制与RRM意愿相关。除了专注于准确的风险沟通外，咨询还应关注感知控制和情绪的影响，以促进决策制定。
