UT SON Dissertations (Open Access)

Date of Award

Fall 12-2019

Degree Name

Doctor of Philosophy in Nursing (PhD)

Advisor(s)

Diane Wardell, PhD

Second Advisor

Joan Engebretson, DrPH

Third Advisor

Geri LoBiondo-Wood, PhD

Fourth Advisor

Marlyn Allicock MPH

Abstract

Background: A breast cancer type 1 and type 2 susceptibility protein (BRCA1/BRCA2) gene mutation carries an 85%- 90% lifetime risk of developing breast cancer and a 27%-65% chance of developing ovarian cancer. There is minimal evidence regarding how psychosexual functioning, the psychological well-being in regards to body image and sexuality, affects the decision to have prophylactic treatment in women of childbearing age (18 - 49) with a BRCA gene mutation. Diagnosis of a BRCA gene mutation presents a dilemma where life-changing medical decisions must be made to prevent breast and ovarian cancer. Throughout decision-making and following surgical prophylactic interventions, such as a bilateral prophylactic mastectomy (BPM) and bilateral salpingo-oophorectomy (BPSO), there are continued effects on social and sexual functioning related to body image, the partners perception, sexual attractiveness and femininity which further affects the woman’s psychological well-being.

Aim: The aim of the study was to explore the role of psychosexual functioning in the decision to have prophylactic treatment amongst women of childbearing age who have a diagnosis of a BRCA1/BRCA2 gene mutation.

Methods: A focused medically applied ethnographic design was employed to assist the researcher in exploring, interpreting and describing the experience of women of childbearing age with a BRCA mutation. A purposive sample of 18 women between the ages of 21-49 participated in semi-structured interviews exploring their experience after BRCA diagnosis.

Results: Interpretive descriptive analysis revealed four major themes: Body image, Sexuality, Femininity and Childbearing/Childrearing. Women that had undergone BPM (n=8) were concerned about the effects of the surgery, scarring, breast disfigurement and lack of sensation. Although some of the women had not received surgical prophylaxis they all voiced concerns regarding body image and sexuality that caused some hesitancy in their decision-making to have prophylactic surgery.

Conclusion: This study postulates that psychosexual concerns come from both internal and external influences that significantly impact the decision to undergo prophylactic measures. Body image, sexuality and sexual orientation should be addressed at first contact and considered while developing a plan of care. Although women may have support from family or significant others during the decision-making process psychosexual concerns may not be addressed.

Keywords

Body Image, BRCA mutation, Decision Making, Prophylactic Mastectomy, Psychosexual Functioning, Sexuality

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Nursing Commons

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