Public perceptions and preferences for CT colonography or colonoscopy in colorectal cancer screening

Ghanouni, Alex; Smith, Samuel G.; Halligan, Steve; Plumb, Andrew; Boone, Darren; Magee, Molly Sweeney; Wardle, Jane; Wagner, Christian von

doi:10.1016/j.pec.2012.05.007

Cited by 22 publications

(29 citation statements)

References 15 publications

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“…The finding that women generally preferred to be overdiagnosed than underdiagnosed is consistent with previous survey findings of high tolerance levels of false-positive results15 and a fear of false-negative results identified in qualitative work38; in other words women appear to value sensitivity over specificity, which has been found in qualitative studies in other screening as well as diagnostic contexts 3940 But this is the first study, to our knowledge, to have explicitly explored the notion of overdiagnosis in the UK breast screening context.…”

Section: Discussionsupporting

confidence: 89%

Women's responses to information about overdiagnosis in the UK breast cancer screening programme: a qualitative study

et al. 2013

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ObjectivesTo explore the influence of overdiagnosis information on women's decisions about mammography.DesignA qualitative focus group study with purposive sampling and thematic analysis, in which overdiagnosis information was presented.SettingCommunity and university settings in London.Participants40 women within the breast screening age range (50–71 years) including attenders and non-attenders were recruited using a recruitment agency as well as convenience sampling methods.ResultsWomen expressed surprise at the possible extent of overdiagnosis and recognised the information as important, although many struggled to interpret the numerical data. Overdiagnosis was viewed as less-personally relevant than the possibility of ‘under diagnosis’ (false negatives), and often considered to be an issue for follow-up care decisions rather than screening participation. Women also expressed concern that information on overdiagnosis could deter others from attending screening, although they rarely saw it as a deterrent. After discussing overdiagnosis, few women felt that they would make different decisions about breast screening in the future.ConclusionsWomen regard it as important to be informed about overdiagnosis to get a complete picture of the risks and benefits of mammography, but the results of this study indicate that understanding overdiagnosis may not always influence women's attitudes towards participation in breast screening. The results also highlight the challenge of communicating the individual significance of information derived from population-level modelling.

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Section: Discussionsupporting

confidence: 89%

Women's responses to information about overdiagnosis in the UK breast cancer screening programme: a qualitative study

et al. 2013

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“…its ability to detect CRC or the practicalities of what it involves) and investigate aspects that are likely to dissuade or encourage them to undergo it, as well as participants' underlying reasons (e.g. [16]). …”

Section: How Are Preferences Measured?mentioning

confidence: 99%

Public preferences for colorectal cancer screening tests: a review of conjoint analysis studies

Ghanouni

Smith

Halligan

et al. 2013

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A wide range of screening technologies is available for colorectal cancer (CRC) screening. There is demand to discover public preferences for these tests on the rationale that tailoring screening to preferences may improve uptake. This review describes a type of study (conjoint analysis) used to assess people's preferences for CRC screening tests and critically evaluates research quality using a recently published set of guidelines. Most primary studies assessed preferences for colonoscopy and faecal occult blood testing but newer technologies (e.g. capsule endoscopy) have not yet been evaluated. Although studies often adhered to guidelines, there was limited correspondence between stated preferences and actual screening behaviour. Future research should investigate how studies can go beyond the guidelines in order to improve this and also explore how test preferences may differ by important population subgroups.

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“…However, few studies have quantified these costs and those that have suggest they are valued very differently by patients; one study found women would accept 500 false-positive mammograms to avoid a single missed cancer [12]. While qualitative research suggests that attendees value sensitivity over specificity when screening for colorectal cancer [13], [14] this has not been quantified. Ignoring these preferences may underestimate test benefit.…”

Section: Introductionmentioning

confidence: 99%

Patients' & Healthcare Professionals' Values Regarding True- & False-Positive Diagnosis when Colorectal Cancer Screening by CT Colonography: Discrete Choice Experiment

et al. 2013

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PurposeTo establish the relative weighting given by patients and healthcare professionals to gains in diagnostic sensitivity versus loss of specificity when using CT colonography (CTC) for colorectal cancer screening.Materials and MethodsFollowing ethical approval and informed consent, 75 patients and 50 healthcare professionals undertook a discrete choice experiment in which they chose between “standard” CTC and “enhanced” CTC that raised diagnostic sensitivity 10% for either cancer or polyps in exchange for varying levels of specificity. We established the relative increase in false-positive diagnoses participants traded for an increase in true-positive diagnoses.ResultsData from 122 participants were analysed. There were 30 (25%) non-traders for the cancer scenario and 20 (16%) for the polyp scenario. For cancer, the 10% gain in sensitivity was traded up to a median 45% (IQR 25 to >85) drop in specificity, equating to 2250 (IQR 1250 to >4250) additional false-positives per additional true-positive cancer, at 0.2% prevalence. For polyps, the figure was 15% (IQR 7.5 to 55), equating to 6 (IQR 3 to 22) additional false-positives per additional true-positive polyp, at 25% prevalence. Tipping points were significantly higher for patients than professionals for both cancer (85 vs 25, p<0.001) and polyps (55 vs 15, p<0.001). Patients were willing to pay significantly more for increased sensitivity for cancer (p = 0.021).ConclusionWhen screening for colorectal cancer, patients and professionals believe gains in true-positive diagnoses are worth much more than the negative consequences of a corresponding rise in false-positives. Evaluation of screening tests should account for this.

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Public perceptions and preferences for CT colonography or colonoscopy in colorectal cancer screening

Cited by 22 publications

References 15 publications

Women's responses to information about overdiagnosis in the UK breast cancer screening programme: a qualitative study

Women's responses to information about overdiagnosis in the UK breast cancer screening programme: a qualitative study

Public preferences for colorectal cancer screening tests: a review of conjoint analysis studies

Patients' & Healthcare Professionals' Values Regarding True- & False-Positive Diagnosis when Colorectal Cancer Screening by CT Colonography: Discrete Choice Experiment

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