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Empowered Choices: African-American Women's Breast Reconstruction Decisions

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Objectives: Breast reconstruction (BR) potentially can improve quality of life in postmastectomy breast cancer survivors (BCS); however, African-American women are less likely to undergo BR than Caucasian women. This qualitative study was undertaken to explore individual, sociocultural, and contextual factors influencing African-American women's BR decision-making processes and preferences. Methods: Postmastectomy African-American BCS with and without BR participated in semi-structured interviews. We adopted a grounded theory approach using the constant comparison method to understand the contexts and processes informing participants' BR decision-making. Results: Twenty-three women participated, of whom 17 elected BR and 6 did not. Whereas women's primary reasons for deciding for or against BR differed, our core category, "empowered choices ," describes both groups' decision-making as a process focused on empowering themselves physically and/or psychologically, through self-advocacy, informed and shared decision-making, and giving back/receiving communal and spiritual support from church and African-American survivor groups. Socioeconomic factors influenced women's access to BR. Women preferred autologous BR and expressed the need for greater culturally-matched resources and support to inform treatment and shared BR decision-making. Conclusions: Understanding and supporting African-American women's BR preferences and empowerment is essential to ensuring equal access, and culturally-relevant, high-quality, and informed patient-centered care.
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Keywords: AFRICAN AMERICANS; BREAST CANCER; BREAST RECONSTRUCTION; CANCER SURGERY; HEALTH DISPARITIES; MASTECTOMY

Document Type: Research Article

Affiliations: 1: Shahnjayla K. Connors, Assistant Professor, Department of Social Sciences, University of Houston-Downtown, Houston, TX, United States 2: Isabel Martinez Leal, Research Associate II, Social and Behavioral Science, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States;, Email: [email protected] 3: Vijay Nitturi, Research Assistant, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States 4: Chisom N. Iwundu, Postdoctoral Fellow, Department of Psychological Health and Learning Sciences, University of Houston, Houston, TX, United States 5: Valentina Maza, Research Assistant, Department of Psychological, Health, and Learning Sciences, University, Houston, Houston, TX, United States 6: Stacey Reyes, Research Assistant, Department of Social Sciences, University of Houston-Downtown, Houston, TX, United States 7: Chiara Acquati, Assistant Professor, Graduate College of Social Work, University of Houston, Houston, TX, United States 8: Lorraine R. Reitzel, Professor, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States

Publication date: March 1, 2021

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  • The American Journal of Health Behavior seeks to improve the quality of life through multidisciplinary health efforts in fostering a better understanding of the multidimensional nature of both individuals and social systems as they relate to health behaviors.

    The Journal aims to provide a comprehensive understanding of the impact of personal attributes, personality characteristics, behavior patterns, social structure, and processes on health maintenance, health restoration, and health improvement; to disseminate knowledge of holistic, multidisciplinary approaches to designing and implementing effective health programs; and to showcase health behavior analysis skills that have been proven to affect health improvement and recovery.

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