Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Do Unclothed Images Affect Decision Making In A Conjoint Analysis?
Malik Mossa-Basha, MD 20141, Peter Ubel, MD2, Lillian Burdick, BA3, Lillie Williamson, BA2, Clara Lee, MD3.
1Wayne State University, Detroit, MI, USA, 2Duke University, Durham, NC, USA, 3University of North Carolina, Chapel Hill, NC, USA.

Purpose: Conjoint analysis is a powerful technique for eliciting preferences, which enables consumers to make multiple simultaneous trade-offs in choosing a product. Recently, health service researchers have been using conjoint analysis to learn more about which attributes patients’ value when making health care choices. Prior research in marketing has demonstrated strong effects of images on consumers’ choices, but the effect of images within conjoint questionnaires is unknown. For the medical decision about reconstruction after mastectomy, images of breasts could be particularly relevant.
We aim to evaluate the effects of adding unclothed or clothed images to a questionnaire on breast cancer reconstruction surgery choices.
Methods: We enrolled adult women ages 40 to 70 who had no history of breast cancer through online sampling sources. Participants complete an online conjoint analysis questionnaire consisting of 13 questions with a choice between two treatment breast cancer surgeries that varied according to 4 different attributes_appearance, complication rate, number of surgeries and recovery time. Participants were randomized into one of four groups different only by what images they were shown. The images were realistic computer generated representations of what patients would look like after surgery. The groups included unclothed images, clothed images, both or no images. We analyzed the responses using Sawtooth Software. The outcome of interest was the average importance of the appearance attribute.
Results: 105 participants completed the study. Two were excluded_one for being a male and the other for leaving multiple questions blank. The unclothed, clothed, both and no images groups had average importance ratings of 25.49, 16.90, 27.95, and 20.88 respectively (p<.05). 19% of subjects in the unclothed group ranked the appearance attribute as most important while 12% of the clothed group ranked appearance as most important. The group with both images had the most participants ranking appearance as most important at 33%. The no-images group had 13% of subjects ranking appearance as the most important attribute.
Conclusion: The presence of images was associated with a greater appearance rating. The impact of images was greater in the unclothed than in the clothed group. Unclothed images had a greater emotional impact on subjects. As a result, the method by which healthcare providers present patients with information on surgeries could impact decision making.


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