Evaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy Process

Abstract

Background In 2021, the United States Preventive Services Task Force updated their recommendation, stating that individuals ages 45-49 should initiate screening for colorectal cancer. Since several screening strategies are recommended, making a shared decision involves including an individual’s preferences. Few studies have included individuals under age 50. In this study, we use a multicriteria decision analysis technique called the Analytic Hierarchy Process to explore preferences for screening strategies and evaluate whether preferences vary by age. Methods Participants evaluated a hierarchy with 3 decision alternatives (colonoscopy, fecal immunochemical test, and computed tomography colonography), 3 criteria (test effectiveness, the screening plan, and features of the test) and 7 sub-criteria. We used the linear fit method to calculate consistency ratios and the eigenvector method for group preferences. We conducted sensitivity analysis to assess whether results are robust to change and tested differences in preferences by participant variables using chi-square and analysis of variance. Results Of the 579 individuals surveyed, 556 (96%) provided complete responses to the AHP portion of the survey. Of these, 247 participants gave responses consistent enough (CR < 0.18) to be included in the final analysis. Participants that were either white or have lower health literacy were more likely to be excluded due to inconsistency. Colonoscopy was the preferred strategy in those < 50 and fecal immunochemical test was preferred by those over age 50 (p = 0.002). These results were consistent when we restricted analysis to individuals ages 45-55 (p = 0.011). Participants rated test effectiveness as the most important criteria for making their decision (weight = 0.555). Sensitivity analysis showed our results were robust to shifts in criteria and sub-criteria weights. Conclusions We reveal potential differences in preferences for screening strategies by age that could influence the adoption of screening programs to include individuals under age 50. Researchers and practitioners should consider at-home interventions using the Analytic Hierarchy Process to assist with the formulation of preferences that are key to shared decision-making. The costs associated with different preferences for screening strategies should be explored further if limited resources must be allocated to screen individuals ages 45-49.

Colorectal cancer knowledge and perceptions among individuals below the age of 50

“…Aversion to colonoscopy has been well documented and recommendations for other screening or detection methods may be better received 24,25 . We recommend a shared‐decision making approach to ensure complete understanding of the range of CRC screening options and the corresponding risks and burden 26‐29 . Providers should be prepared to tailor discussions of screening options to patients' presentation, personal preferences, and concerns.…”

“…24,25 We recommend a shared-decision making approach to ensure complete understanding of the range of CRC screening options and the corresponding risks and burden. [26][27][28][29] Providers should be prepared to tailor discussions of screening options to patients' presentation, personal preferences, and concerns. Perceptions of screening among our participants were generally favorable; however, women rated the importance of screening significantly lower compared with men and the importance of screening should be highlighted for women.…”

Fecal immunochemical test (FIT) versus colonoscopy: Does knowing that a positive FIT requires a follow-up colonoscopy affect initial decision making in the US?

“…Although many people strongly prefer noninvasive stool testing over colonoscopy for initial CRC screening ( von Wagner et al, 2020 , Hyams et al, 2021 , Zhu et al, 2021 ), it is possible this preference would change if people explicitly understood that a positive stool test must be followed up with a colonoscopy. However, in the case of FIT testing, our study indicates that explicitly instructing people that + FIT requires a colonoscopy does not alter decision making when choosing between FIT and colonoscopy for initial CRC screening.…”

“…In the US, fecal immunochemical test (FIT) and colonoscopy are the most common screening modalities for colorectal cancer (CRC), and they are tier 1 tests according to the US Multi-Society Task Force (MSTF) on CRC ( Rex et al, 2017 , Shaukat et al, 2021 ). Although many people prefer FIT over colonoscopy due to its noninvasive nature ( von Wagner et al, 2020 , Hyams et al, 2021 , Zhu et al, 2021 ), it is unclear whether FIT would still be preferred if people were explicitly informed that a + FIT requires a follow-up colonoscopy. To address this gap, we administered two conjoint analysis surveys—one that explained the need for a follow-up colonoscopy after + FIT while the other did not.…”

Correction to: Evaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy Process

“…Following publication of the original article [ 1 ], some content was missing in Funding section. The updated Funding is given below and the missing content have been highlighted in bold typeface.…”