Attributes Used for Cancer Screening Discrete Choice Experiments: A Systematic Review

Abstract

Background: Evidence from discrete choice experiments (DCEs) can be used to enrich understanding of preferences, inform the (re)design of screening programs and/or improve communication within public campaigns about the benefits and harms of screening. However, reviews of screening DCEs highlight significant discrepancies between stated choices and real choices, particularly regarding willingness to undergo cancer screening. The identification and selection of attributes and associated levels is a fundamental component of designing a DCE. Misspecification or misinterpretation of attributes may lead to non-compensatory behaviours, attribute non-attendance and responses that lack external validity.Objectives: To synthesise evidence on attribute development, alongside an in-depth review of included attributes and methodological challenges, to provide a resource for researchers undertaking future studies in cancer screening.Methods: A systematic review was conducted to identify DCEs estimating preferences towards cancer screening, dated between 1990 and December 2020. Data were synthesised narratively. In-depth analysis of attributes lead to classification into four categories: testspecific, service delivery, outcomes and monetary. Attribute significance and relative importance were also analysed. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) conjoint analysis checklist was used to assess the quality of reporting.Results: Forty-nine studies were included at full-text. They covered a range of cancer sites: over half (26/49) examined colorectal screening. Most studies elicited general public preferences (34/49). In total, 280 attributes were included, 90% (252/280) of which were significant. Overall, test sensitivity and mortality reduction were most frequently found to be the most important to respondents.Conclusions: Improvements in reporting the identification, selection and construction of attributes used within cancer screening DCEs are needed. This review also highlights the importance of considering the complexity of choice tasks when considering risk information or compound attributes. Patient and public involvement and stakeholder engagement are recommended to optimise understanding of unavoidably complex choice tasks throughout the design process. To ensure quality and maximise comparability across studies, further research is needed to develop a risk of bias measure for DCEs.

Attributes Characterizing Colorectal Cancer Screening Tests That Influence Preferences of Individuals Eligible for Screening in Germany: A Qualitative Study

“… 17 , 18 Besides needing further research for theoretical validation, this finding stresses the importance of applying a mixed-methods design in identifying and selecting attributes for a DCE to ensure that the final attributes used to characterize the alternatives available for choice are relevant to the target population and have an impact on overall utility. 9 , 11 , 14 …”

“…17,18 Besides needing further research for theoretical validation, this finding stresses the importance of applying a mixed-methods design in identifying and selecting attributes for a DCE to ensure that the final attributes used to characterize the alternatives available for choice are relevant to the target population and have an impact on overall utility. 9,11,14 Sedation is an attribute in which screening tests differ from each other: While sedation is not required for fecal testing, data from England show that a diagnostic colonoscopy is almost always performed under conscious sedation. 34 Similar results are also available from Germany, where sedation is given in 86.6% of screening colonoscopies.…”

“… 12 Though recommended, the use of qualitative methods in the process of identifying and selecting attributes has often only been stated in previous DCE publications, but without reporting the methodological approaches and results in detail. 13 , 14 To address this gap, and to consider the potential target populations’ perspectives in the process of identifying and selecting attributes for the DCE in the SIGMO study, the objective of this qualitative study was to identify attributes characterizing CRC screening tests that are relevant for individuals eligible for screening in Germany.…”

Women’s priorities towards ovarian cancer testing: a best–worst scaling study

“…The prioritisation of outcome and test-specific characteristics and the relative lack of importance placed on service delivery characteristics is reflective of findings from the wider literature examining preferences towards cancer screening and diagnosis. 20 29–32 The relative importance of ‘openness of healthcare providers’ is echoed by qualitative research exploring the diagnostic experiences of women with ovarian cancer where shortcomings in doctor–patient communication was a recurring theme. In particular, patients raised concerns about doctors’ willingness and ability to openly communicate and share information.…”

“…We performed a systematic review of the preference-based literature to identify characteristics relating to cancer testing. 20 Potential characteristics were then narrowed down by the authors based on relevance to ovarian cancer testing in symptomatic patients using an iterative Delphi method process where exclusion required full agreement of the research team. In total, 25 characteristics were selected for inclusion ( table 1 ).…”