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

Area of Science:

• Health Services Research
• Patient-Reported Outcomes
• Decision Science

Background:

• Colorectal cancer (CRC) screening involves tests with diverse characteristics, making it a preference-sensitive decision for patients.
• Understanding patient values is crucial for effective CRC screening uptake and adherence.

Purpose of the Study:

• To evaluate patient experiences using a Maximum Differences Scaling (MDS) tool for assessing colorectal cancer (CRC) screening test characteristics.
• To determine if patient prioritization of CRC screening test attributes varies and if this relates to their test preferences.

Main Methods:

• A Maximum Differences Scaling (MDS) survey was administered to elicit patient values regarding characteristics of various CRC screening tests.
• Participants included 92 patients from primary care clinics at a VA hospital and associated university.
• Tested CRC screening methods included fecal occult blood testing, sigmoidoscopy, colonoscopy, CT colonography, and colon capsule endoscopy.

Main Results:

• The MDS tool was reported as easy to use by 95% of patients.
• Post-survey, 62% preferred colonoscopy, 23% colon capsule endoscopy, and 10% CT colonography.
• Key valued attributes were sensitivity, risk of complications, and need for a repeat test. Sensitivity was more critical for those preferring colonoscopy. Age influenced concerns about complications, sedation, and preparation. Health status impacted the importance of sensitivity.

Conclusions:

• This pilot study indicates significant patient variation in prioritizing colorectal cancer screening test attributes, directly linked to their preferences.
• The MDS tool demonstrated feasibility and potential utility in helping patients articulate and construct their screening test preferences.
• Findings support the use of preference-elicitation tools to personalize colorectal cancer screening decisions.