Measuring Patient Preferences for Colorectal Cancer Screening Using a Choice-Format Survey

Marshall, Deborah; Johnson, F. Reed; Phillips, Kathryn A.; Marshall, John K.; Thabane, Lehana; Kulin, Nathalie A.

doi:10.1111/j.1524-4733.2007.00196.x

Cited by 128 publications

(173 citation statements)

References 59 publications

(69 reference statements)

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“…The relationship did not change after controlling for task, country, and demographic characteristics (OR 0.19, 95 % CI 0.14, 0.27; p<0.0001). 11,14 In this study, slightly more than half of respondents selected risk reduction as most important. Those who did not may have perceived the risk of CRC and the reduction in risk as being very small and thus did not consider this attribute to be "important."…”

Section: Intent To Be Screenedmentioning

confidence: 80%

“…Some studies have found considerable variation in how people value different attributes, but have not assessed variation across different countries. 11,14,15 By studying the US and Australia, we were able to examine how values and preferences for screening differ in two countries with similar wealth but with differences in how CRC screening has been implemented. US guidelines recommend several options for screening, but implementation has been ad hoc.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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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.

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Section: Intent To Be Screenedmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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“…24 Although we are not aware of other published studies that have compared different methods of values elicitation for CRC screening, several have used explicit techniques to assess key decisional attributes. 13,[25][26][27][28] (Details of these studies are provided in Appendix 5-available online) Most studies have found test accuracy (ability to detect cancer and polyps) to be the most common most important attribute, but the order of importance of other attributes has varied considerably across studies.…”

Section: Discussionmentioning

confidence: 99%

Conjoint Analysis Versus Rating and Ranking for Values Elicitation and Clarification in Colorectal Cancer Screening

et al. 2011

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PURPOSE:To compare two techniques for eliciting and clarifying patient values for decision making about colorectal cancer (CRC) screening: choicebased conjoint analysis and a rating and ranking task. METHODS: Using our decision lab registry and university e-mail lists, we recruited average risk adults ages 48-75 for a written, mailed survey. Eligible participants were given basic information about CRC screening and six attributes of CRC screening tests, then randomized to complete either a choice-based conjoint analysis with 16 discrete choice tasks or a rating and ranking task. The main outcome was the most important attribute, as determined from conjoint analysis or participant ranking. Conjoint analysisbased most important attribute was determined from individual patient-level utilities generated using multinomial logistic regression and hierarchical Bayesian modeling. RESULTS: Of the 114 eligible participants, 104 completed and returned questionnaires. Mean age was 57 (range 48-73), 70% were female, 88% were white, 71% were college graduates, and 62% were up to date with CRC screening. Ability to reduce CRC incidence and mortality was the most frequent most important attribute for both the conjoint analysis (56% of respondents) and rating/ranking (76% of respondents) groups, and these proportions differed significantly between groups (absolute difference 20%, 95% CI 3%, 37%, p =0.03). There were no significant differences between groups in proportion with clear values (p = 0.352), intent to be screened (p = 0.226) or unlabelled test preference (p=0.521) CONCLUSIONS: Choice-based conjoint analysis produced somewhat different patterns of attribute importance than a rating and ranking task, but had little effect on other outcomes.

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“…Many (including the USPSTF) have argued that providing patients with a choice of mode will increase CRC screening adherence 4,[10][11][12] . This perspective has been challenged by concerns that "information overload" resulting from too many options might lead some patients to opt out of screening altogether 13,14 .…”

Section: Introductionmentioning

confidence: 99%

“…Extending this assumption to health behavior, if there is variation in preferences regarding the most desirable attributes of a product or service across individuals and these attributes can be varied across products or services, then offering a wide variety of products or services (representing a range of potentially desirable attributes) will be preferable because it will increase the likelihood that each individual will find and act on an option that satisfies his or her unique preferences. Studies comparing preferences for four or more recommended CRC screening options do suggest there is variation in mode preferences and the value patients assign to attributes related to preferences 11,[19][20][21][22][23][24][25] . However, evidence that the vast majority of patients prefer either FOBT or colonoscopy [20][21][22][23]25 calls into question the value of investing in the more rarely preferred screening modalities, particularly in settings where high adherence rates have already been achieved using a screening approach emphasizing a single mode [26][27][28] .…”

Section: Introductionmentioning

confidence: 99%

Bringing an Organizational Perspective to the Optimal Number of Colorectal Cancer Screening Options Debate

et al. 2011

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Improving colorectal cancer (CRC) screening rates represents a challenge for primary care providers. Some have argued that offering a choice of CRC screening modes to patients will improve the currently low adherence rates. Others have raised concerns that offering numerous CRC screening options in practice could overwhelm patients and thus dampen enthusiasm for screening. In this article we assemble evidence to critically evaluate the relative merit of these opposing views. We find little evidence to support the hypothesis that the number of options offered will affect adherence (either positively or negatively), or that expanding the modalities offered beyond FOBT and colonoscopy will improve patient satisfaction. Therefore, we assert future decisions about the number of CRC screening modes to offer would more productively be focused on considerations such as what benefit the health-care organization would derive from offering additional modes, and how this change would affect other critical components of a successful screening program such as timely diagnosis. In light of these organizational level considerations, we agree with the assertion made by others that a screening program limited to FOBT and colonoscopy is likely to be ideal in most settings.KEY WORDS: colorectal neoplasms; mass screening; choice behavior; decision making; organizational decision making.

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Measuring Patient Preferences for Colorectal Cancer Screening Using a Choice-Format Survey

Abstract: Our findings emphasize the important role of patient preferences for no screening and in selecting alternative CRC screening modalities. CRC screening implementation in Canada should consider patient preferences to optimize uptake.

Cited by 128 publications

References 59 publications

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

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

Conjoint Analysis Versus Rating and Ranking for Values Elicitation and Clarification in Colorectal Cancer Screening

Bringing an Organizational Perspective to the Optimal Number of Colorectal Cancer Screening Options Debate

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