Sun Clement S, Cantor Scott B, Reece Gregory P, Crosby Melissa A, Fingeret Michelle C, Markey Mia K
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.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
Plast Reconstr Surg Glob Open. 2014 Mar;2(3):e125. doi: 10.1097/GOX.0000000000000062.
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.
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.
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.
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.
考虑进行乳房重建的女性必须在常常相互冲突的问题之间做出具有挑战性的权衡。使用单一汇总指标对可能的结果进行量化，可能有助于乳腺癌患者选择乳房重建的方式。
在本研究中，我们使用多属性效用理论，结合多个目标，采用九种不同的偏好模型得出一个汇总值。我们征集了36名年龄在32岁及以上且无乳腺癌病史的女性对患者报告的结局指标的偏好，这些指标包括乳房满意度、心理社会幸福感、胸部健康状况、腹部健康状况和性健康状况，通过BREAST-Q进行测量，此外还包括重建所花费的时间和自付费用。参与者对假设的乳房重建结果进行排序。我们检查了每个多属性效用偏好模型，并评估每个模型与参与者排序的一致程度。
评估偏好所需的中位时间为34分钟。九个偏好模型与参与者之间的一致性范围为75.9%至78.9%。没有一个偏好模型的表现明显比表现最佳的风险厌恶乘法模型差。如果将参与者的误差包括在内，我们假设该模型的平均理论一致性为94.6%。七个属性的权重分配越不均衡，相关性在统计学上越显著为正。
我们推荐使用风险厌恶乘法模型来模拟考虑不同乳房重建方式的患者的偏好，因为在本研究中它与参与者的一致性最高。
