ObjectivePrevivor is a term applied to a person with an identified, elevated lifetime cancer risk but without an actual cancer diagnosis. Previvorship entails the selection of risk management strategies. For women with a genetic mutation that increases their predisposition for a breast cancer diagnosis, bilateral risk‐reducing mastectomy (BRRM) is the most effective prevention strategy. However, BRRM can change a woman's breast appearance and function. The purpose of this qualitative metasynthesis (QMS) was to better understand the decision‐making process for BRRM among previvors.MethodsA theory‐generating QMS approach was used to analyze and synthesize qualitative findings. Research reports were considered for inclusion if: (1) women over 18 years of age possessed a genetic mutation increasing lifetime breast cancer risk or a strong family history of breast cancer; (2) the sample was considering, or had completed, BRRM; (3) the results reported qualitative findings. Exclusion criteria were male gender, personal history of breast cancer, and research reports which did not separate findings based on cancer diagnosis and/or risk‐reduction surgery.ResultsA theory and corresponding model emerged, comprised of seven themes addressing the decision‐making process for or against BRRM. While some factors to decision‐making were decisive for surgery, others were more indefinite and contributed to women changing, processing, or suspending their decision‐making for a period of time.ConclusionsRegardless of the decision previvors make about BRRM, physical and psychosocial well‐being should be considered and promoted through shared decision‐making in the clinical setting.

中文翻译：

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双侧风险降低乳房切除术增加终生乳腺癌风险的决策：定性荟萃分析

ObjectivePrevivor 这个术语适用于已确定的终生癌症风险较高但没有实际癌症诊断的人。生前需要选择风险管理策略。对于携带增加乳腺癌诊断倾向的基因突变的女性，双侧风险降低乳房切除术 (BRRM) 是最有效的预防策略。然而，BRRM 可以改变女性乳房的外观和功能。这种定性荟萃分析 (QMS) 的目的是更好地了解幸存者中 BRRM 的决策过程。方法采用理论生成 QMS 方法来分析和综合定性研究结果。如果满足以下条件，则考虑纳入研究报告：(1) 18 岁以上的女性患有增加终生乳腺癌风险的基因突变或有明显的乳腺癌家族史；(2) 样本正在考虑或已经完成 BRRM；(3)结果报告定性发现。排除标准是男性、个人乳腺癌病史以及未根据癌症诊断和/或降低风险手术分开研究结果的研究报告。结果出现了一个理论和相应的模型，由七个主题组成，解决了癌症的决策过程。或反对 BRRM。虽然决策的某些因素对手术具有决定性，但其他因素则更加不确定，会导致女性在一段时间内改变、处理或暂停决策。结论无论前人对 BRRM 做出的决定如何，身体和心理社会健康状况良好。应通过临床环境中的共同决策来考虑和促进。