title: Assessing Women's Preferences and Preference Modeling for Breast Reconstruction Decision-Making.
abstract: BACKGROUND
  Women considering breast reconstruction must make challenging trade-offs amongst issues that often conflict. It may be useful to quantify possible outcomes using a single summary measure to aid a breast cancer patient in choosing a form of breast reconstruction.
  
  
  METHODS
  In this study, we used multiattribute utility theory to combine multiple objectives to yield a summary value using nine different preference models. We elicited the preferences of 36 women, aged 32 or older with no history of breast cancer, for the patient-reported outcome measures of breast satisfaction, psychosocial well-being, chest well-being, abdominal well-being, and sexual wellbeing as measured by the BREAST-Q in addition to time lost to reconstruction and out-of-pocket cost. Participants ranked hypothetical breast reconstruction outcomes. We examined each multiattribute utility preference model and assessed how often each model agreed with participants' rankings.
  
  
  RESULTS
  The median amount of time required to assess preferences was 34 minutes. Agreement among the nine preference models with the participants ranged from 75.9% to 78.9%. None of the preference models performed significantly worse than the best performing risk averse multiplicative model. We hypothesize an average theoretical agreement of 94.6% for this model if participant error is included. There was a statistically significant positive correlation with more unequal distribution of weight given to the seven attributes.
  
  
  CONCLUSIONS
  We recommend the risk averse multiplicative model for modeling the preferences of patients considering different forms of breast reconstruction because it agreed most often with the participants in this study.
authors.affiliation: Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX ; Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Clement S
authors.initials: CS
authors.lastname: Sun
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Reece
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Crosby
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX ; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Fingeret
authors.affiliation: Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX ; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Mia K
authors.initials: MK
authors.lastname: Markey
keywords: BREAST-Q; Multiattribute utility theory; breast reconstruction; consistency; decision analysis; decision-making; multiple objectives; patient reported outcome measures; risk attitude; utility
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