School of Psychology, The University of Sydney, Camperdown, NSW, Australia.
Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Camperdown, NSW, Australia.
Psychooncology. 2018 Oct;27(10):2349-2356. doi: 10.1002/pon.4830. Epub 2018 Sep 4.
Risk-reducing mastectomies (RRM) and contralateral prophylactic mastectomies (CPM) are increasingly prevalent strategies to reduce breast cancer risk. Given the associated physical and emotional challenges, presurgical psychological assessment is frequently recommended for this population, yet limited research exists to guide this. This study aimed to reach a consensus on the most relevant content and format of a psychological consultation prior to RRM/CPM.
A modified two-round online Delphi study was conducted Australia-wide. Expert participants (n = 25), including psychologists, surgeons, nurses, oncologists, genetic specialists, and researchers completed a round-one survey, informed by a literature review, previous qualitative study and expert clinicians' input. This required participants to rate their agreement with 36 statements regarding potential content of a psychological consultation and provide feedback on format/structure. A round-two survey comprised items that had not reached consensus and six new items suggested by participants. Parameters for statement consensus were set a priori at >75% agreement.
Expert participants indicated agreement with the majority of statements (39/42, 92.8%), endorsing that the assessment should include (1) patient understanding of the RRM/CPM procedure/cancer risk, (2) potential physical/emotional impact of surgery, (3) informed decision-making, and (4) past/current psychological issues (anxiety and body image). A provisional assessment template and user manual is provided.
This research culminated in a consensus-based template to guide psychological assessment of women considering RRM/CPM. This enables health professionals to assess suitability for surgery and preempt challenges within a standardised framework. Future evaluation of the acceptability and effectiveness of the template in clinical settings is warranted.
降低风险的乳房切除术（RRM）和对侧预防性乳房切除术（CPM）是越来越流行的降低乳腺癌风险的策略。鉴于其相关的身体和情感挑战，该人群通常需要进行术前心理评估，但指导这种评估的研究有限。本研究旨在就 RRM/CPM 术前心理咨询的最相关内容和形式达成共识。
在澳大利亚进行了一项改良的两轮在线德尔菲研究。包括心理学家、外科医生、护士、肿瘤学家、遗传专家和研究人员在内的 25 名专家参与者完成了一轮调查，该调查基于文献回顾、先前的定性研究和专家临床医生的意见。这要求参与者对 36 条关于心理咨询潜在内容的陈述进行评估，并就格式/结构提供反馈。第二轮调查包括未达成共识的项目和参与者提出的六个新项目。陈述一致性的参数在预先设定为>75%的一致性。
专家参与者对大多数陈述（39/42，92.8%）表示同意，即评估应包括（1）患者对 RRM/CPM 程序/癌症风险的理解，（2）手术的潜在身体/情绪影响，（3）知情决策，以及（4）过去/当前的心理问题（焦虑和身体形象）。提供了一个临时评估模板和用户手册。
这项研究最终达成了一个基于共识的模板，以指导考虑 RRM/CPM 的女性的心理评估。这使卫生专业人员能够在标准化框架内评估手术的适宜性并预测挑战。未来有必要在临床环境中评估该模板的可接受性和有效性。
