Challenges in Decision‐Making for Contralateral Prophylactic Mastectomy in Korea: A Qualitative Study of Perspectives of Patients With Hereditary Breast Cancer and Providers

Background The uptake of contralateral prophylactic mastectomy (CPM) has increased among patients with breast cancer and BRCA ‐pathogenic variants. However, CPM decision‐making remains complex, involving various risks and benefits, and requiring comprehensive patient support. This study explored patients' and healthcare providers' (HCPs') perspectives during CPM decision‐making in the Korean healthcare context. Methods Semi‐structured interviews were conducted with 17 patients with breast cancer and BRCA pathogenic variants and 10 HCPs (7 breast surgeons, 3 advanced practice nurses) between August and September 2024. A reflexive thematic analysis was conducted based on Charles's decision‐making model. Results Three themes emerged across decision‐making stages for both patients and HCPs. Patients needed more information and guidance during the information exchange phase. In contrast, HCPs hesitated to guide decision‐making due to limited CPM evidence, negative perceptions of CPM, and time constraints. During the deliberation phase, patients required more counseling and trust‐building with HCPs. However, HCPs faced resource constraints (time, staff, space), hindering these supports. In the decision‐making phase, patients' preferences varied, ranging from autonomous to physician‐led decisions, whereas HCPs maintained neutrality, recognizing patients as primary decision‐makers. These opposing positions create a mismatch in decision‐making role expectations between patients and HCPs. Conclusion This study highlights gaps and challenges in information, support, and decision‐making roles between patients and HCPs. A shared decision‐making approach, backed by insurance reimbursement, could help bridge these gaps. Providing additional resources— counseling time, staffing, space, and decision aids—may improve patient‐centered decision‐making in the Korean healthcare context.