What is most important to patients when deciding about colorectal screening?

Abstract

Background: Colorectal cancer (CRC) screening can be administered through tests with varied characteristics and is a preference-sensitive decision.

Objective: To assess patient experiences with a Maximum Differences Scaling (MDS) tool for eliciting values about CRC screening test characteristics and determine whether patients vary in how they prioritize test characteristics and whether this variation relates to test preferences.

Design: MDS survey to elicit patients' values for characteristics related to fecal occult blood testing, sigmoidoscopy, colonoscopy, CT colonography and colon capsule endoscopy.

Participants: 92 patients enrolled in primary care clinics at a VA hospital and associated university.

Results: Patients reported that the tool was easy to use (95%). On completion 62% would choose colonoscopy, 23% colon capsule endoscopy and 10% CT colonography. Of the attributes evaluated, patients valued sensitivity, risk of tear and need for a second test most. Sensitivity was more important to those choosing colonoscopy than those choosing other tests (median importance = 21.5 versus 19.6, p < 0.01). Concern with complications and sedation was positively associated with age (p < 0.001 and p < 0.001), whereas concern with colon preparation and missing work was negatively associated with age (p < 0.009 and p < 0.03). Patients with fair or poor health status were less concerned with sensitivity than patients in good to excellent health (median importance = 19.3 versus 21.4, p < 0.008).

Conclusions: This pilot study suggests that patients vary in how they prioritize colorectal cancer screening test attributes; this variation is associated with test preferences, and this MDS tool is feasible to use and may help patients construct their preferences.

Figure 1

Example of a MDS question. Figure 1 shows an example page, 1 of 12, of various combinations and arrangements of the attributes, which patients responded to in the survey.

Figure 2

Illustrative rank ordering of all attributes for two individuals. Figure 2 shows the rank order of all the attributes for two individual patients. Black bar: 79-year-old man, unemployed, fair health status, preferred FOBT. Grey bar: 50-year-old man, employed, good health status, preferred colonoscopy. The labels are as follows: Second: the need to have a second test; Swallow: the need to swallow a capsule; Tube: the need to have a tube in the rectum; Work: the need to take a day off from work; Ride: the need to get a ride home; Pain: the risk of pain; Sed: the rare risk of a problem from sedation; Prep: the need to clean the bowel by drinking a preparation; FOBT: the need to collect your stool on cards; Stuck: the rare risk that the capsule can get stuck; Tear: the rare risk of a tear or bleeding; Sensitivity: how good the test is at finding polyps and preventing cancer.