The development of a template for psychological assessment of women considering risk-reducing or contralateral prophylactic mastectomy: A national Delphi consensus study.

Braude L1, Kirsten L2,3,4, Gilchrist J5, Juraskova I1,2,3.

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Abstract

OBJECTIVE:

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, pre-surgical 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.

METHODS:

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.

RESULTS:

Expert participants indicated agreement with the majority of statements (39/42, 92.8%), endorsing that the assessment should include: i) patient understanding of the RRM/CPM procedure/cancer risk, ii) potential physical/emotional impact of surgery, iii) informed decision-making, and iv) past/current psychological issues (anxiety, body image). A provisional assessment template and user manual is provided.

CONCLUSIONS:

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 standardized framework. Future evaluation of the acceptability and effectiveness of the template in clinical settings is warranted.