Decisions surrounding risk-reducing salpingo-oophorectomy (RRSO): experiences of BRCA-positive women
Bibliographic record
Abstract
Women with pathogenic or likely pathogenic variants in BRCA1 or BRCA2 (“BRCA-positive”) have an increased risk of developing high grade serous ovarian cancer (HGSOC). The majority of HGSOC develops in the fallopian tubes and later spreads to the ovaries and peritoneal cavity. Therefore, BRCA-positive women may consider risk-reducing salpingo-oophorectomy (RRSO) to preventatively remove their ovaries and fallopian tubes. The Hereditary Gynecology Clinic (HGC) in Winnipeg specifically targets care to the unique needs of BRCA-positive women through an interdisciplinary team of gynecological oncologists, menopause specialists, and registered nurses. A mixed-methods study design was used to explore the decision-making processes of BRCA-positive women considering (or who completed) RRSO, and how this decision was influenced by experiences with healthcare providers at the HGC. BRCA-positive women without a previous diagnosis of HGSOC and who had previously received genetic counselling were recruited from the HGC and the Shared Health Program of Genetics & Metabolism. Forty-three women completed a survey and 15 completed an interview about their experiences and decisions surrounding RRSO. Surveys were analyzed to compare scores on validated scales related to decision-making and cancer-related worry. Interviews were transcribed, coded, and analyzed using a generic qualitative research approach called interpretive description, which is a commonly used to explore clinical phenomena. The results of this study demonstrated that BRCA-positive women face complex decisions that are intertwined with unique experiences. BRCA-positive women interpreted their HGSOC risk through a personalized “lens” of contextual factors that impacted perceptions about the practical and emotional implications of RRSO, and therefore the need for surgery. Mean scores on validated scales evaluating the HGC’s impact on decisional outcomes and preparedness for decision-making about RRSO were not significant, indicating that the HGC played a supportive role for BRCA-positive women rather than helping with decision-making itself. Strategies for improving support, decisional outcomes, and the overall experiences of BRCA-positive women attending the HGC are described.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.019 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.004 | 0.006 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".