PREDICTORS OF RISK PERCEPTION AND CHOICE IN SURGICAL DECISION MAKING

Purpose: This study is the first empirical test of the effect of identity on risk perception and risky choice in surgical decision-making.

Method: Respondents (n=374) randomized into gain or loss conditions made choices, provided quantitative and qualitative risk perception measures, and responded to a demographic questionnaire. Two control vignettes and two experimental vignettes were presented to each subject. Each vignette offered a choice between a sure versus a risky option. Experimental vignettes were identical except for the reason for surgery: double mastectomy for female-to-male gender dysphoria (GD) diagnosis or double mastectomy for breast cancer diagnosis. Subjects provided estimates of perceived risk and benefits for each vignette. Quantitative surgical risk perception was measured on a 0 to 100 probability scale. Qualitative (global) risk perception was measured using verbal descriptors: “none”, “low”, “medium”, or “high.” Gender identity, sexual orientation identity, frame, and vignette were independent measures. Choice outcome, risk perception, and benefit perception were dependent measures.

Result: As in standard framing effects, overall, subjects chose the risky option more in the vignettes when the choice was presented in terms of losses. Identity was a significant predictor of both risky choice and risk perception (quantitative and global); males displayed the most risk-taking, transgender subjects displayed the least risk-taking. Subjects were overall more willing to take risks in the cancer vignette than in the GD vignette, although the decision in the GD vignette was perceived as more risky in the loss frame. Surgical outcomes and probabilities were identical across the cancer and GD vignettes, but quantitative surgical risks, global surgical risks, and global surgical benefits were perceived differently. Gender identity and vignette interacted for perceived benefits; males rated benefits of surgery as significantly higher for the cancer than GD vignettes, and females perceived less of a difference, but there was no difference in perceived benefits across the GD and cancer mastectomy surgeries among transgender respondents.

Conclusion: Although objectively identical, subjects evaluated the surgical risk in gender dysphoria and cancer decision vignettes differently. This study marks the first empirical test of how sexual and gender minorities perceive risks and benefits in medical decision-making.