Cognitive Appraisal, Coping Behaviors, and Decisional Outcomes in Women Making a Treatment Decision for Their Increased Risk of Breast Cancer

This cross-sectional descriptive correlational study was conducted to examine the relationships between and among the threat of breast cancer (objective and subjective risk), subjective stress, decisional conflict (uncertainty and factors associated with uncertainty), type of coping (approach and avoidance coping behaviors), and decisional outcome (treatment choice and decision effectiveness) in women making a treatment choice for their increased risk of developing breast cancer. The sample consisted of 105 women who came to a high risk breast cancer clinic for a breast cancerrisk assessment. Participants' ages ranged from 35-72. The majority of the women were married, Caucasian, highly educated, and employed fulltime. A booklet with four self-report questionnaires was used for data collection including a sociodemographic questionnaire developed by the researcher, Horowitz's Impact of Event Scale, O'Connor's Decisional Conflict Scale, and Lazarus and Folkman's Ways of Coping Revised Questionnaire.Each hypothesis in the study was at least partially supported. Subjective stress and decision uncertainty were significant predictors for using approach coping behavior, but only subjective stress significantly predicted the use of avoidance coping behavior. The variance in treatment choice was significantly explained by subjective 5-year risk, factors associated with decision uncertainty, and objective risk, while the variance in decision effectiveness was significantly explained by decision uncertainty and factors associated with decision uncertainty. Lastly, approach coping behavior explained a small but significant amount of the variance in decision effectiveness.Women at risk for developing breast cancer used approach and avoidance coping behaviors to manage the stress associated with their increased risk for breast cancer and consideration of treatment options. Women who used approach coping felt more certain about their treatment choice. Avoidance coping tended to be used by women who were uncertain about their treatment choice with a marginally significant positive relationship between avoidance coping and decision uncertainty. Women who were knowledgeable and clear about their values related to treatment options were more apt to select chemoprevention or prophylactic mastectomy, when appropriate, and felt they made an effective decision.

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