| "Why have rates of prophylactic bilateral oophrectomy in women without risk factors remained at 50%, since the late 1980's despite the growing body of evidence that documents severe and debilitating health consequences, up to and including premature death, associated with its use?" This was the research question that drove this dissertation. Annually, 300,000 women without risk factors for breast or ovarian cancer undergo this surgical procedure, which raises questions of the procedure's medical necessity and potential health risks precipitated with its use. To better understand clinical decision-making and evidence-based support for the use of prophylactic bilateral oophrectomy in women without risk factors, this qualitative research included interviews with 35 OB/GYN's in academic health centers across the United States.;In 1958, Culiner first raised questions regarding this surgical procedure's medical necessity in women without risk factors and potential health risks precipitated by its use. Now, Parker and colleagues (2009) provide additional clinical evidence of these health risks including an increased incidence of all-cause mortality, both fatal and non-fatal coronary vascular disease and lung cancer. The dissertation research found that for over 35 years, prophylactic bilateral oophrectomy in women without risk factors, widely assumed to be life-enhancing, has been inducing a wide variety of chronic disabling conditions, and causing premature death in many women. This phenomenon has occurred unbeknownst to many specialists performing the procedure and many patients who consented to it.;Several institutional and behavioral factors were found to contribute to this phenomenon. First, organizational imprinting has occurred as senior faculty, reflecting the prevailing wisdom of the 1970's, have promulgated the benefits of prophylaxis. Second, training for uncertainty during medical residency excludes data on adverse effects of the procedure. Third, the social construction of clinical views results in differences of opinion on risk-benefit ratios of the procedure. Fourth, groupthink , a faulty form of decision-making, leads physicians and governing bodies to focus on the benefits of the procedure, without paying equal attention to the risks.;Following Timmermans (2003), who first positioned EBM in the sociological literature, this dissertation illustrates the reconfiguration of medical knowledge through clinical decision-making and guidelines.;Keywords: incidental bilateral oophrectomy, organizational imprinting, social construction of clinical views, groupthink, evidence-based medicine. |
