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Very simple and straightforward. And so, somewhat skeptically, I wrote those 200 or so words

The finding of adenocarcinoma in the biopsy specimen from the patient with Pagets disease warrants a total vulvectomy with bilateral inguinal-femoral groin node dissections

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Responses were provided on a 5-point Likert scale (e.g., 1 = A lot more appealing to 5 = A lot less appealing) and were subsequently re-coded into a binary variable as either a 1 (a little / a lot more appealing) or 0 (a little / a lot less appealing and no difference)