Poster Presentation Joint 2016 COSA and ANZBCTG Annual Scientific Meeting

Assessing patient suitability for risk-reducing mastectomy: a psychologist’s role. (#269)

Lucy Braude 1 , Ilona Juraskova 1 2 , Rebekah Laidsaar-Powell 1 2 , Jemma Gilchrist 3 , Laura Kirsten 2 4
  1. School of Psychology, University of Sydney, Sydney, NSW, Australia
  2. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, NSW, Australia
  3. Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
  4. Nepean Cancer Care Centre, Sydney West Cancer Network, Penrith, NSW, Australia

Aim: Increasingly RRM is the preferred intervention to reduce the risk of developing breast cancer amongst women who have an identified risk. Health professionals (HPs) often refer patients to psychologists for assessment prior to RRM. For psychologists to do so effectively, there is a need to more clearly define and standardise the role of the psychologist in this process. This would ensure effective psychological evaluation of patients and support to the multidisciplinary team. This qualitative study aimed to explore the current role of a psychologist in pre-surgical psychological assessment of women undergoing RRM. 

Methods: Twenty-five HPs (surgeons, psychologists, genetic counselors and breast care nurses) were recruited from tertiary breast cancer institutions, specialist breast cancer centres and established group for psychologists working in oncology. Participants completed semi-structured interviews (n=15) or participated in a focus group (n=10). Data collection occurred until data saturation. Interviews were audiotaped, transcribed and qualitatively analysed using Framework analysis methods.

Results: Health professionals indicated that psychologists had a varied and dynamic role in the assessment of women undergoing RRM. Qualitative analysis revealed four themes: (1) perceived patient motivation to undergo RRM; (2) health professional reasons for psychologist referral; (3) role of the psychologist; (4) value of psychologist involvement. The proposed role of the psychologist included: assessing patient understanding of information, assessing psychological state, assisting with informed decision-making and preparing the patient for a smooth adjustment. HPs reported that psychologist involvement reassured the multidisciplinary team and provided emotional support to patients that HPs felt was valuable but beyond their time constraints and/or training.

Conclusions: Understanding the psychologists’ role will provide guidance for HPs working with women seeking RRM. The current findings will inform the development of a standardised psychological assessment protocol that can be widely used by psychologists treating this population.