• Megan McQuirter, Luisa Luciani Castiglia, Carmen G Loiselle, and Nora Wong.
• Cardiac Care Unit, Royal Victoria Hospital, Montreal, Quebec, Canada. megan.mcquirter@mail.mcgill.ca
• Oncol Nurs Forum. 2010 May 1;37(3):313-20.

Purpose/ObjectivesTo explore the decision-making process of women with a BRCA1 or BRCA2 gene mutation who have chosen to undergo prophylactic mastectomy.DesignCross-sectional, qualitative, descriptive design.SettingParticipants were recruited from an outpatient cancer prevention center in the oncology and medical genetics departments of a large university-affiliated hospital in Montreal, Quebec, Canada.Sample10 women carrying a BRCA1 or BRCA2 mutation; 8 previously had had a prophylactic mastectomy and 2 were scheduled for surgery at the time of study.MethodsSemistructured, in-depth interviews were conducted. Field notes were written and audiotapes were transcribed verbatim. The textual data were coded and analyzed.Main Research VariablesDecision-making process for prophylactic mastectomy.FindingsTwo broad findings emerged. First, several intrapersonal and contextual factors interacted throughout the process to move women either closer to choosing a prophylactic mastectomy or further from the decision. Second, all women reported experiencing a "pivotal point," an emotionally charged event when the decision to have a prophylactic mastectomy became definitive. Pivotal points for patients included either receiving a positive result for a genetic mutation or a breast cancer diagnosis for herself or a family member in the context of positive mutation status.ConclusionsDecision making about prophylactic mastectomy was an affective and intuitive process incorporating contexts and their relations rather than a rational, straight-forward process of weighing pros and cons.Implications For NursingSupportive interventions for women in this population should explicitly address the individual and the inter-relationships of contextual factors that shape decision making about prophylactic mastectomy while recognizing important affective components involved.

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