Colorectal Cancer Screening Preferences of Recipients and Providers: A Dual-Perspective Discrete Choice Experiment

The low participation rate in colorectal cancer (CRC) screening may be partly attributed to the lack of consideration for the preferences of both Recipients and Providers. This study aims to explore these preferences to inform the optimization of screening design and the improvement of implementation strategies.

A discrete choice experiment (DCE) was conducted in Shandong Province to examine CRC screening preferences of Recipients and Providers. The attributes and levels of the DCE were determined using a systematic literature review and explored qualitatively. Questionnaires were generated through a partial factor design, and used a mixed logit model to analyze the data. Relative importance scores (RIS) and marginal willingness to pay were used to quantify preferences, and probability density functions were employed to predict changes in participation rates under varying attribute levels.

Preference data from 570 Recipients and 532 Providers were analyzed. The DCE included five attributes: screening cost (four levels), screening interval (four levels), bowel preparation (two levels), screening accuracy (three levels), and reduction in CRC-related mortality risk (three levels). All attributes significantly influenced preferences. The RIS indicated that Recipients prioritized screening cost (42.8%), followed by interval (24.3%), mortality risk reduction (16.2%), accuracy (10.7%), and bowel preparation (6.0%), whereas Providers emphasized bowel preparation (35.4%), interval (31.7%), cost (25.1%), mortality risk reduction (6.4%), and accuracy (1.3%). Both groups showed strong support for biennial screening. Shortening the interval from 10 to 2 years increased Recipients' willingness to pay by CNY 1052.95 and Providers' expected charge by CNY 1370.84, which was also associated with higher predicted participation rates.

Recipients and Providers differed in the degree of preference for the five CRC screening attributes, but the directions of their preferences were consistent. Therefore, screening strategies should aim to balance the perspectives of both groups. Where feasible, a biennial screening program that includes bowel preparation, minimizes costs and mortality risk, and maximizes accuracy is recommended.