There is growing interest from health policy makers in eliciting consumer preferences for health care services. This is particularly the case when assessing the likely impact of innovations. Some people may be wary of innovations because they prefer the service they have previously experienced. Consumer preferences for an existing and a hypothetical new bowel cancer testing programme were measured using a discrete choice experiment questionnaire. The results showed that consumers had a statistically significant preference for the existing service (status quo) when all other factors remained constant. It suggested that consumers make decisions under a 'veil of experience'. Possible explanations for this result include the endowment effect, status quo bias and loss aversion. Future evaluations of health service innovation should be aware of this tendency to favour the status quo.

Objectives To determine which aspects of the treatment decision process, therapy and outcomes are most important to patients with colorectal cancer (CRC).Design Cross-sectional survey.Participants A total of 102 men and 73 women who had completed primary treatment for CRC in two teaching hospitals in Central Sydney, Australia.Main outcomes measures Patient's rating of the importance of the decision-making aspects and outcomes of treatment for CRC.Results Trust in their surgeon and confidence of specialty training are of paramount importance to CRC patients. Patients also have a strong desire to get on with treatment quickly and rate the risk of disease recurrence and quality of life as being very important in their treatment decisions. Gender, age and whether the patient had undergone adjuvant radiotherapy were all significant predictors of preferred mode of treatment decision-making. Fifty-eight per cent of women preferred a shared decision-making role compared with 36% of men, whilst older patients and those who had undergone adjuvant radiotherapy were significantly more likely to prefer that their surgeon decide upon treatment when compared with younger patients and respondents who have not had radiotherapy.Conclusions Regardless of whether a patient prefers an active or more passive role in decision-making, having a surgeon explain treatment options in a clear, unhurried and open manner is vital to how patients feel about their treatment. Whilst acknowledging that individual patients will have different needs for information and preferences for treatment, there are several factors amongst many in the process of decision-making which are considered very important by patients with CRC. A surgeon who adopts a consultation 104

This investigation provided important perspectives regarding oral health and dental access for older people residing in the community and demonstrated the importance of understanding this group when considering provision and use of services.

Objectives: To elicit community preferences for colorectal cancer (CRC) screening by faecal occult blood test (FOBT) using discrete choice modeling (DCM). To provide policymakers with information that would assist them in designing the future national screening program. Research suggests that consumers want more infor mation about their health care options and, for some, a more active role in making decisions about their treatment. 1 The movement towards e vidence-based information and the centrality of individual patient choice and values in decision making has been described as a shift towards 'evidence-based consumer choice'. 1 At the same time, there is growing interest in the use of community preferences to inform health services planning and delivery. 2 Together, evidence-based consumer choice and recognition of community preferences in health planning pose new challenges for population health such as screening for colorectal cancer (CRC). MethodsElsewhere, the General Medical Council in the United Kingdom (UK) has guidelines about information that should be given to people considering screening tests. 3 These guidelines state that information should be provided about the purpose of screening, its uncertainties such as the risks of a f alse positive or false negative result and any significant medical, social and f inancial implications of screening for individuals and their relatives. 3 To our knowledge, there are no similar guidelines in Australia. Yet recent Australian research has shown that women want to be well informed about the possibility of f alse test results when participating in mammography screening and the risks of any adv erse effects of tests. 4 Women repor t receiving information on the benefits of tests and treatments signif icantly more often than they received information on adverse effects. 4 Consumer preferences ought to influence the deliver y of CRC screening. There are a number of ways to elicit consumer preferences, either revealed preferences (based on actual choices) or stated preference (based on hypothetical choices). We used stated preference to assist policymakers in the design of a future national screening program. Stated preference methods include the concept of QALYs (quality adjusted life years), In public health, DCM has been applied to primary health care services, 6 varicella vaccination, 7 genetic screening, 8 breast cancer screening 9 and the Rotary Bowelscan (a community-based CRC testing program). 10 The aim of this present study was to assess community decisions about CRC screening based on the trial evidence on harms and benef its. The community in this study was the eligible CRC screening population, men and women aged 50-70 years, living in central Sydney. We also aimed to provide policy makers with infor mation that would assist them in designing the future national screening program. 11 Article Methods and Concepts MethodsWe followed DCM principles and protocols as follows. 2 Stage 1: Determining attributesThrough informal networks of community ...

Our results endorse the role of the GP in bowel cancer screening. However, the study also has demonstrated that test accuracy, the convenience of the screening service and notification of test results are valued differently by subgroups in the community, according to their level of education.