Supplementary Material for: Factors Impacting on Decision-Making towards Prophylactic Surgeries in BRCA Mutation Carriers and Women with Familial Predisposition

Background/Objectives: BRCA mutation carriers and women at high risk of breast/ovarian cancer are faced with the intricate question to opt for prophylactic surgeries and/or a periodic screening. The aim of this study was therefore to identify objective and emotional factors that have an impact on the decision-making process. Methods: Ninety-five women with BRCA mutations or women at increased breast/ovarian cancer lifetime risk were counseled at our outpatient department and either opted for prophylactic surgery or periodic screening. To identify the psychological factors that could have influenced the decision-making, a standardized questionnaire was applied. Additionally, clinical data were collected and were reviewed by a personal talk. Results: Seventy-one of the patients opted for an increased surveillance only, 21 for prophylactic surgeries. Positive predictors for prophylactic surgeries were sociodemographic characteristics such as parity and objective variables such as verified mutation status. Hierarchical regression analysis revealed that the need for safety in health issues has been the only significant psychological predictor of surgery beyond the objective factors. Fear of surgical procedures, menopausal symptoms after surgery, loss of attractiveness, or fear of interferences with sexual life did not significantly affect decision-making. Conclusion: Decision-making towards prophylactic surgeries is influenced by objective but also emotional factors. Knowing that fear and anxiety also have an important impact on decision-making, distinct counselling about the procedures, the subsequent risk reduction as well as the psychological effects of prophylactic surgeries are essential.

背景与目的：BRCA突变携带者（BRCA mutation carriers）以及乳腺癌、卵巢癌高危女性面临着选择预防性手术或定期筛查的复杂抉择。本研究旨在明确对决策过程产生影响的客观与情感因素。
方法：本研究纳入95名BRCA突变携带者或终身乳腺癌、卵巢癌发病风险升高的女性，均在我院门诊接受咨询，并最终选择预防性手术或定期筛查。为明确可能影响决策的心理因素，研究采用标准化调查问卷进行调查。此外，研究还收集了临床数据，并通过个人访谈进行复核。
结果：71名患者仅选择加强监测随访，21名选择预防性手术。预防性手术的正向预测因子包括生育胎次等社会人口学特征，以及确诊突变状态等客观变量。分层回归分析显示，在客观因素之外，健康相关安全需求是唯一对手术选择具有显著影响的心理预测因子。对手术操作的恐惧、术后更年期症状、魅力丧失或担忧性生活受干扰等因素，均未对决策产生显著影响。
结论：预防性手术的决策过程同时受客观与情感因素影响。鉴于恐惧与焦虑同样对决策具有重要作用，因此针对手术操作、术后风险降低效果以及预防性手术的心理影响开展针对性咨询至关重要。