Risk-reducing mastectomies (RRM) and contralateral prophylactic mastectomies (CPM) are increasingly prevalent strategies to reduce breast cancer risk. Since RRM and CPM procedures may have negative physical and emotional sequelae, pre-surgical psychological assessments are frequently recommended. However, limited research exists to guide psychologists/health professionals on the assessment. This study aimed to reach a consensus on the most relevant and appropriate content and format of a psychological consultation prior to RRM/CPM.
A modified two-round online Delphi study was conducted nationally. Expert participants (n=25), including psychologists, surgeons, nurses, oncologists, genetic specialists and academic (breast cancer) researchers completed a survey (Round 1), informed by a literature review, qualitative study and expert clinicians’ input. Participants rated their agreement with 36 statements regarding potential content of the psychological consultation. Additional statements required feedback on format and structure of the potential assessment. Experts (n=21) completed a second round of survey statements that had not reached consensus and new items suggested by participants. Parameters for statement consensus were set a priori at <75% agreement and data was analysed using descriptive statistics.
Expert clinicians/academics indicated agreement with the majority of statements (39/42, 92.8%), endorsing that assessment should include: patient understanding of the procedure, their breast cancer risk, the potential physical and emotional impact of surgery, informed decision-making and past and current psychological issues (anxiety, mood, body image). In addition, experts endorsed advising a post-operative consultation when feasible. Feedback also highlighted the need for flexibility within the assessment process given the diversity of psychologist/surgery contexts. A recommended assessment template will be outlined.
The current findings informed the development of a standardised psychological assessment template that can be used by psychologists treating this population. Future evaluation of the acceptability and effectiveness of the proposed template in the clinical setting is warranted.