Decision making about prophylactic oophorectomy among at-risk women: Psychological influences and implications

Objective. Women with a family history of ovarian cancer are confronted wit h difficult decisions regarding the management of their risk status, Curren tly, the main preventive option available is prophylactic oophorectomy. The objective of the present paper is to review research and theory on psychol ogical factors that influence decision making about preventive surgery and discuss the implications for patient management. Methods. Guided by a cognitive-social framework, the literature on decision making about preventive surgery is reviewed and integrated. Results. The available studies show that women are more likely to opt for s urgery if they feel more vulnerable to cancer, believe that surgery will pr event cancer, and are worried about developing cancer. Further, the respons e to ovarian risk is influenced by the individual's characteristic psycholo gical style: monitors (who typically scan for and amplify threatening cues) tend to feel more vulnerable to cancer and more distressed about their can cer risk than blunters (who typically distract from threatening cues) do. Conclusion. On the basis of prior research, monitors may be more likely to choose surgical intervention to reduce their distress, without fully antici pating the psychological and medical consequences of that decision. In orde r to facilitate informed decision making, counseling protocols should be de signed to enable the patient to understand and take account of the psycholo gical consequences of the available medical options. Future studies are nee ded to systematically extend and explore the proposed theory-based relation ships. (C) 1999Academic Press.