Patients prioritize local recurrence risk over other attributes for surgical treatment of facial melanomas - results of a stated preference survey and choice-based conjoint analysis

Publication date: Available online 2 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Jeremy R. Etzkorn, Scott D. Tuttle, Ilya Lim, Elea M. Feit, Joseph F. Sobanko, Thuzar M. Shin, Donald E. Neal, Christopher J. Miller
BackgroundSurgical treatment options for facial melanomas include conventional excision with postoperative margin assessment (CE-POMA), Mohs micrographic surgery with immunostains (MMS-I) or slow Mohs. Patient preferences for these surgical options have not been studied.ObjectivesTo evaluate patient preferences for surgical treatment of facial melanoma and to determine how patients value the relative importance of different surgical attributes.MethodsParticipants completed a two-part study consisting of a stated preference survey and a choice-based conjoint analysis (CBCA) experiment.ResultsPatients overwhelmingly (94.3%) rate local recurrence risk as "very important" and rank it as the most important attribute of surgical treatment for facial melanoma. Via CBCA, patients ranked the following surgical attributes from highest to lowest importance: local recurrence rate, out-of-pocket cost, chance of second surgical visit, timing of reconstruction, travel time, and time in office for the procedure. Consistent with their prioritization of low local recurrence rates, over 73% of respondents selected MMS-I or slow Mohs as their preferred treatment option for a facial melanoma.LimitationsData were obtained from a single health system.ConclusionPatients prefer surgical treatment options that minimize risk for local recurrence. Logistics for travel and treatment have less influence on patient preferences. Most survey participants chose MMS-I to maximize local cure and convenience of care.