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Updated: Jul 25, 2025
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Decisional Conflict, Patient Involvement, and the Associated Psychological Factors Relating to Mastectomy Decisions
Jing Liu1, Sally Wai-Chi Chan, Dongmei Guo
1Author Affiliations: School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia (Ms Liu, Dr Hunter, and Prof Lee); The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong (Prof Lee); and President Office, Tung Wah College (Prof Chan), Hong Kong; Department of Breast Surgery, Zhongshan Hospital Xiamen University (Ms Guo); and Department of Radiation Oncology, Xiamen Cancer Quality Control Center, The First Affiliated Hospital of Xiamen University (Prof Lin), Fujian; and School of Medicine, Xiamen University, Xiamen (Prof Lin and Prof Zhu), China.
Background:
Most women with breast cancer in China have received a mastectomy despite emerging breast-conserving alternatives. Their decision-making relating to mastectomy is unclear.
Objective:
To investigate decisional conflict, women's involvement, and psychological factors relating to mastectomy decisions.
Methods:
Women with breast cancer 18 years and older who had a mastectomy were recruited from 2 hospitals in China. A conceptual framework adapted from the Ottawa Decisional Support Framework was used to guide this study. Data were collected using the 16-item Decisional Conflict Scale, the 9-item Shared Decision-Making Questionnaire, and a 19-item psychological factor list.
Results:
A total of 304 women participated. Overall, they reported a low-level conflict and high-level involvement. "Cancer not return" was rated as the most important psychological factor influencing mastectomy decisions. Lower decisional conflict was predicted by higher involvement. Higher involvement was predicted by younger age and increased family income.
Conclusions:
This study is the first to demonstrate decisional conflict, involvement, and the associated factors specifically in Chinese women undergoing mastectomy. Results determined the importance of several psychological factors influencing mastectomy decisions. Future qualitative studies are required to deepen understanding of women's decision-making experiences regarding this surgery.
Implications For Practice:
Nurses need to provide support to Chinese women in making treatment decisions, especially for older women, and those who are economically disadvantaged. Measures are needed to promote their involvement and improve their understanding of breast cancer and its treatments, which may help reduce decisional conflict, and potentially improve their satisfaction with treatment and quality of life.
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