Preferences for different diagnostic modalities to follow up abnormal colorectal cancer screening results: a hypothetical vignette study

Abstract

ObjectivesIn England, a significant proportion of people who take part in the national bowel cancer screening programme (BCSP) and have a positive faecal occult blood test (FOBt) result, do not attend follow-up colonoscopy (CC). The aim of this study was to investigate differences in intended participation in a follow-up investigation by diagnostic modality offered including CC, CT colonography (CTC) or capsule endoscopy (CE).SettingWe performed a randomised online experiment with individuals who had previously completed an FOBt as part of the English BCSP.MethodsParticipants (n=953) were randomly allocated to receive one of three online vignettes asking participants to imagine they had received an abnormal FOBt result, and that they had been invited for a follow-up test. The follow-up test offered was either: CC (n=346), CTC (n=302) or CE (n=305). Participants were then asked how likely they were to have their allocated test or if they refused, either of the other tests. Respondents were also asked to cite possible emotional and practical barriers to follow up testing. Multivariable logistic regression models were used to investigate intentions.ResultsIntention to have the test was higher in the CTC group (96.7%) compared with the CC group (91.8%; OR 2.64; 95% CI 1.22 to 5.73). CTC was considered less ‘off-putting’ (OR 0.66, 95% CI 0.47 to 0.94) and less uncomfortable compared with CC (OR 0.51, 95% CI 0.34 to 0.77). For those who did not intend to have the test they were offered, CE (39.7%) or no investigation (34.5%) was preferable to CC (8.6%) or CTC (17.2%).ConclusionsAlternative tests have the potential to increase attendance at diagnostic follow-up appointments.

Effects of a modified invitation letter to follow‐up colonoscopy for bowel cancer detection

“…For instance, participants were asked to imagine and rate their expected concern about travel costs to a hypothetical place they may have never visited before, and they were also asked to record anticipated rather than actual state anxiety experiences. However, it is worth noting that other recent research has successfully adopted a similar design to the current study, asking participants to imagine they had received a positive FOBt or to imagine cancer symptom presentation (Goodwin et al., 2021; Kaushal et al., 2020; Marcu et al., 2019; Saab et al., 2021). Moreover, conducting research with this particular patient population in real life is challenging given the reduced number of people invited to attend further tests following routine screening; therefore, utilizing hypothetical vignette approaches represents a useful research tool in this context.…”

“…Previous quantitative research provides insight into patient emotional and practical barriers to follow-up colonoscopy (Kaushal et al, 2020;Plumb et al, 2017). For example, Kaushal et al (2020)…”

“…For example, Kaushal et al. (2020) conducted a hypothetical online vignette survey with 953 English participants, asking them to imagine they had received a positive faecal occult blood test (FOBt). Barriers to having a follow‐up investigation included time constraints, more frequently cited by participants in employment or from ethnic minority groups, and difficulties with transport among participants living in areas of higher deprivation.…”

Evaluation of the safety, efficacy and feasibility of ‘at-home’ capsule endoscopy

“…Throughout the procedure, patients are required to wear a belt with a data recorder (12) while continuing their daily activities as usual. CE is perceived as a more comfortable and less embarrassing procedure compared to colonoscopy (13). Both CCE and PCCE require bowel preparation, while SBCE may or not involve laxatives.…”

Colonografia por tomografia computadorizada versus colonoscopia para diagnóstico de câncer colorretal: revisão sistemática e metanálise

“…Para os casos de rastreio e de investigação em pacientes sintomáticos ainda há muito debate e, portanto, a CTC está indicada apenas se a CO for inviável ou se houver recusada pelo paciente.Quanto a consideração da vontade do paciente para a realização de um ou outro exame, é importante ressaltar que esta pode divergir muito. Em estudo recente Kaushal et al41 entrevistaram pacientes com resultados de FOBT positivo quanto a sua preferência no seguimento de investigação, e encontraram uma maior taxa de pacientes que preferem realizar CTC a CO (96,7 vs. 91.8%; OR 2,64; com IC95% 1,22-5,73). Diversos estudos anteriores, assim como este, defendem que os pacientes preferem a CTC por ser menos invasivo, porém é importante que se ressalte que o preparo é o mesmo para os dois exames, e ambos são realizados com insuflação dos cólons.…”