Table 3.
Thematised barriers to uptake of risk reducing surgeries
| Themes | Barriers | Quotes |
| RRESDO | ||
| Menopause; satisfaction with treatment choices | Approaching the age of natural menopause | ‘I think my age, I think it’s the fact that they [surgeries] might have ended up being within two or three years, it just didn’t make that much sense to me…’ (ID-20) |
| Cancer risk reduction; sequence of ovarian and breast prophylactic surgeries | Strong family history of OC | ‘I am more concerned about protecting myself from ovarian cancer because I have more relatives with ovarian cancer than breast cancer and so I just want the lot [tubes and ovaries] out.’ (ID-23) |
| Cancer risk reduction: surgical choices | Two staged surgery | ‘To be honest, I think if you’re going to go and have it done, have it done in one. Why would I want, in another 10 years, to go and have surgery again?’ (ID-23) |
| Surgical complications | Concerns over future poor health | ‘I don’t know what my health would be like in 10 years’ time, I might not be up for surgery. I just think get it done, get it over and done with now.’ (ID-20) |
| Cancer risk reduction: surgical choices; satisfaction with treatment choices | More effective surgery to reduce OC risk | ‘…I just want to eliminate as much [risk] as possible…’ (ID-20) |
| Fertility | Childbearing not complete | ‘I have not finished having children…’ (ID-01) |
| RRSO | ||
| Fertility | Childbearing not complete | ‘I have not finished having children…’ (ID-14) |
| Fertility | Not wanting to remove healthy tissue | ‘It’s also quite difficult to decide to go through an operation when there’s nothing wrong, so obviously it’s preventative but part of you is like “I'm perfectly healthy, why would I do this?”’(ID-01) |
| Menopause; satisfaction with treatment choices | Early menopause | ‘I was very off put by that [oophorectomy] because I feel I'm too young to be put into the menopause and I'm aware, probably through training as a nurse, the symptoms associated with that, the increased risk of, I would be decreasing my risk obviously of ovarian cancer but then have an increased risk of osteoporosis and all the other things, it was trying to weigh up the best option and I didn’t feel that that’s something I wanted to think of at this moment in time.’ (ID-01) |
| RRM | ||
| Cancer risk reduction: surgical choices | Loss of femininity and self esteem | ‘My breasts are my womanhood and loosing them I think would really effect my self esteem and not in a good way.’ (ID-15) |
| Fertility | Childbearing and breastfeeding not complete | ‘I still need my breasts to breastfeed. I’ve not finished having kids.’ (ID-03) |
| Surgical complications; satisfaction with treatment choices | Major operation with long recovery | ‘…it’s a major operation, psychologically and physically with long recovery.’ (ID-03) |
| Cancer risk reduction: surgical choices | Effective BC screening programme | ‘There is such an effective screening programme, I wouldn’t want surgery unless there was something picked up on a scan.’ (ID-04) |
| Cancer risk reduction: surgical choices | Good prognosis from early screen detected BC | ‘…breast cancer is quite treatable and has often a good prognosis.’ (ID-04) |
| Combined ovarian and breast cancer prevention surgeries | ||
| Sequence of ovarian and breast prophylactic surgeries; satisfaction with treatment choices | Increased duration of postoperative recovery | ‘I would be worried that recovery from such a big operation would be really long.’ (ID-23) |
| Sequence of ovarian and breast prophylactic surgeries; satisfaction with treatment choices | Concerns over increased number of complications | ‘…primarily it will be around the additional risk of complications and side effects from the various elements of the two different surgeries…’ (ID-23) |
| Sequence of ovarian and breast prophylactic surgeries; satisfaction with treatment choices | Psychological distress | ‘I don’t think I would cope well with going into menopause the same time as losing my breasts and all the implications that would have on me feeling like a woman.’ (ID-22) |
BC, breast cancer; HRT, hormone replacement therapy; OC, ovarian cancer; QoL, quality of life; RRESDO, risk-reducing early salpingectomy with delayed oophorectomy; RRSO, risk-reducing salpingo-oophorectomy.