Comparing 3 Values Clarification Methods for Colorectal Cancer Screening Decision-Making: A Randomized Trial in the US and Australia

Abstract

PURPOSE:To compare the effects of three methods of values clarification (VCM): balance sheet; rating and ranking; and a discrete choice experiment (DCE) on decision-making about colorectal cancer (CRC) screening among adults in the US and Australia. METHODS: Using online panels managed by a survey research organization in the US and Australia, we recruited adults ages 50-75 at average risk for CRC for an online survey. Those eligible were randomized to one of the three VCM tasks. CRC screening options were described in terms of five key attributes: reduction in risk of CRC incidence and mortality; nature of the screening test; screening frequency; complications from screening; and chance of requiring a colonoscopy (as initial or follow-up testing). Main outcomes included self-reported most important attribute and unlabeled screening test preference by VCM and by country, assessed after the VCM. RESULTS: A total of 920 participants were enrolled; 51 % were Australian; mean age was 59.0; 87.0 % were white; 34.2 % had a 4-year college degree; 42.8 % had household incomes less than $45,000 USD per year; 44.9 % were up to date with CRC screening. Most important attribute differed across VCM groups: the rating and ranking group was more likely to choose risk reduction as most important attribute (69.8 %) than the balance sheet group (54.7 %) or DCE (49.3 %), p<0.0001; most important attribute did not vary by country (p=0.236). The fecal occult blood test (FOBT)-like test was the most frequently preferred test overall (55.9 %). Unlabeled test choice did not differ meaningfully by VCM. Australians were more likely to prefer the FOBT (AU 66.2 % vs. US 45.1 %, OR 2.4, 95 % CI 1.8, 3.1). Few participants favored no screening (US: 9.2 %, AU: 6.2 %). CONCLUSIONS: Screening test attribute importance varied by VCM, but not by country. FOBT was more commonly preferred by Australians than by Americans, but test preferences were heterogeneous in both countries.KEY WORDS: values clarification; colorectal cancer screening; patient decision support.

Effects of Design Features of Explicit Values Clarification Methods

“…All 3 showed differences regarding some measure of participants' most important attribute in the decision. 14,23,33 One of the comparisons showed difference in choice when the name of the intervention (prostate-specific antigen) was not given, but there was no difference when the name was given. 14 The other 2 studies showed no differences in choice.…”

Developing a Self-Administered Decision Aid for Fecal Immunochemical Test�Based Colorectal Cancer Screening Tailored to Citizens With Lower Educational Attainment: Qualitative Study (Preprint)

“…[30] In general, values clarification methods increase citizens' attention to benefits and harms, and they are considered useful. [46] However, in this Danish setting, the paper format of the values clarification exercise was considered inapplicable. [23] In the present study, the The DA was distributed via email, because most citizens are expected to use eHealth solutions, since digital communication is mandatory.…”

Why Wait Until Our Community Gets Cancer?: Exploring CRC Screening Barriers and Facilitators in the Spanish-Speaking Community in North Carolina

“…Participants were given an opt-out option, “Given these options, I would not get screened”, for each choice task. Sawtooth Software Version 8 was used to design a balanced and efficient set of 16 DCE choice tasks for the English version of the survey; this number of questions has been shown in our past work to be feasible for English-speaking participants to complete [1, 19]. …”