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American Association of Plastic Surgeons

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Understanding Stakeholders’ Preferences For Contralateral Prophylactic Mastectomy: A Conjoint Analysis
Meghana Shamsunder, MPH1, Hina Panchal, MD MPH1, Melissa Pilewskie, MD2, Aaron Hill, MBA3, Shantanu Razdan, MD MSPH1, Clara Lee, MD MPP4, Babak Mehrara, MD1, Evan Matros, MD MMSc. MPH1.
1Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2Breast Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3Sawtooth Software Inc., Provo, UT & School of Communications, Brigham Young University, Provo, UT, USA, 4Division of Plastic and Reconstructive Surgery, University of Ohio,, Columbus,, OH, USA.

PURPOSE:
Despite increasing numbers of women with unilateral breast cancer undergoing contralateral prophylactic mastectomy(CPM), the literature lacks an understanding of stakeholder preferences regarding CPM. This study aims to quantify stakeholder preferences in the CPM decision-making process.
METHODS:
Women with no history of cancer(NoHx), breast cancer survivors(BrCa), and breast(BS) and plastic surgeons(PS) were surveyed using a conjoint analysis. Respondents chose between either unilateral(UM) or bilateral(BM) mastectomy under varying cancer, complication, and surgical conditions. Hierarchical Bayesian models calculated part-worth utilities and importance scores.
RESULTS:
1251 respondents participated with NoHX, BS, and PS placing greatest importance on high rates of surgical complications following BM. BrCA strongly preferred BM regardless of complication risk or low rates of 10-year future cancer risk following UM. BS strongly preferred UM more than comparators, whereas BrCa highly favored BM. NoHX and PS varied their preference for either BM versus UM, depending on other factors. BS were least sensitive to increases in 10-year future cancer risk following UM compared to other stakeholders. Although PS valued breast symmetry more than comparators, symmetry and need for surveillance imaging were least important for all stakeholders.
CONCLUSION:
The shared decision-making process for CPM may be constrained by differences in stakeholder preference. NoHx and BS prefer UM to avoid greater risk of surgical complications; however, BrCA strongly prefer BM, regardless of other factors. Methods to align stakeholder preferences are needed.


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