Table 3 –

Summary of theoretical domains and specific constructs for avoiding contralateral prophylactic mastectomy (CPM) inwomen without hereditary breast cancer syndromes.

Domain	Construct	Sample Quote
Avoiding Contralateral Prophylactic Mastectomy in Women without Hereditary Breast Cancer Syndromes
Knowledge	Scientific Rationale	“I think the data is very clear on this, that those patients do not have a demonstrated genetic abnormality, or a markedly strong family history of breast cancer do not benefit from the removal of a normal breast.” “I generally don’t bring it up, truthfully…Removing the other breast is not recommended, and it’s not necessary.”
Emotion	Stress	“100% of [patients] bring it up, the bane of my existence” “Nobody cares about the data. Zero percent of people, lawmakers included. They do not care. …And if you come out and you speak against something that even remotely is perceived as anti-pink ribbon or anti-breast cancer, people want to stone you.”
	Fear	“Women don’t understand there is a difference between getting another cancer in the other breast and having a recurrence.So they think that having a cancer come back in the other breast is the same breast cancer… that it’s stage four disease.”
Beliefs about Consequences	Outcome Expectancies	“If it makes you sleep better at night, there’s not a lot I can do about it. Psychologically, this [may] be a significant benefit.” “We’ll do [a CPM] as long as you know that it’s for anxiety, for peace of mind, and not for a recurrence or survival benefit.”
	Anticipated Regret	“It’s not necessarily the choice I would make, or would recommend for my loved ones, but that’s their decision. And we make sure that they don’t regret any of the decisions that they make.”
Social Influences	Power	“I tell patients that it is their decision and that I don’t recommend it, but ultimately it’s their decision if they’d like to do it.” “But people value their autonomy above anything else, even fear. That’s just something you have to respect.”
	Social Support	“Friends have told them that [CPM] is the right thing. They confuse a lot of times their situation with another person’s situation.” “Friends have a lot of impact. And that’s the first thing they hear, and of course from people they love, so it’s very hard to convince [patients] that their friends are not correct.”
	Modeling	“The Angelina Jolie effect. I’ve definitely had patients literally say to me, “Well, Angelina Jolie had this done. Why shouldn’t I?” Even though they don’t have a hereditary syndrome.”
Professional Role and Identity	Professional Role	“I am there as their coach and counselor and to educate them and if they decide a different route, I will still follow them.” “I can’t determine what is a value procedure for a patient. I can’t do that. So, it’s the patient’s choice.”