TY - JOUR
T1 - Informed decision making changes test preferences for colorectal cancer screening in a diverse population
AU - Shokar, Navkiran K.
AU - Carlson, Carol A.
AU - Weller, Susan C.
N1 - Funding Information:
Funding support: This research was supported by a grant from a joint American Academy of Family Physicians and American Academy of Family Physicians Foundation Grant Awards Program, NCI K07 CA107052A1 .
PY - 2010
Y1 - 2010
N2 - Purpose: We wanted to better understand patient preferences and decision making about options for colorectal cancer screening. Consistency in patient preferences could improve patient-clinician communication about tests by simplifying and focusing discussions. Methods: In a cross-sectional sample of primary care patients, cognitive ranking tasks were used to estimate patient preferences for fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and double-contrast barium enema before and after consideration of 13 test attributes, such as accuracy and scientific evidence. Patients also ranked the 13 test attributes and attribute descriptions in terms of importance. Friedman's nonparametric test was used to measure overall discrimination among items, and the average Pearson correlation coefficient (r̄) among participants was used to measure the degree of consistency in choices. Results: Participants (n = 168) averaged 62.1 years of age, and 64.3% were of minority racial ethnicity. For test-specific attributes, preferences were for high test accuracy (r̄ = 0.63, P <.001), amount of colon examined (r̄ = 0.64, P <.001), strong scientific evidence for efficacy (r̄ = 0.59, P<.001), minimum discomfort (r̄ = 0.50, P <.001), and low risk of complications (r̄ =0.38, P<.001). When all 13 attributes were considered together, agreement dropped (r̄ = 0.13, P<.001), but attributes considered most important for decision making were test accuracy, scientific evidence for efficacy, amount of colon examined, and need for sedation. Test preferences showed moderate agreement (r̄ = 0.20, P <.001), and choices were fairly consistent before and after exposure to test-specific attributes (k = 0.17, P = .007). Initially the modal choice was fecal occult blood testing (59%); however, after exposure to test specific attributes, the modal choice was colonoscopy (54%). Conclusion: Participants were clear about the attributes that they prefer, but no single test has those attributes. Preferences were varied across participants and were not predictable; clinicians should discuss the full range of recommended tests for colorectal cancer with all patients.
AB - Purpose: We wanted to better understand patient preferences and decision making about options for colorectal cancer screening. Consistency in patient preferences could improve patient-clinician communication about tests by simplifying and focusing discussions. Methods: In a cross-sectional sample of primary care patients, cognitive ranking tasks were used to estimate patient preferences for fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and double-contrast barium enema before and after consideration of 13 test attributes, such as accuracy and scientific evidence. Patients also ranked the 13 test attributes and attribute descriptions in terms of importance. Friedman's nonparametric test was used to measure overall discrimination among items, and the average Pearson correlation coefficient (r̄) among participants was used to measure the degree of consistency in choices. Results: Participants (n = 168) averaged 62.1 years of age, and 64.3% were of minority racial ethnicity. For test-specific attributes, preferences were for high test accuracy (r̄ = 0.63, P <.001), amount of colon examined (r̄ = 0.64, P <.001), strong scientific evidence for efficacy (r̄ = 0.59, P<.001), minimum discomfort (r̄ = 0.50, P <.001), and low risk of complications (r̄ =0.38, P<.001). When all 13 attributes were considered together, agreement dropped (r̄ = 0.13, P<.001), but attributes considered most important for decision making were test accuracy, scientific evidence for efficacy, amount of colon examined, and need for sedation. Test preferences showed moderate agreement (r̄ = 0.20, P <.001), and choices were fairly consistent before and after exposure to test-specific attributes (k = 0.17, P = .007). Initially the modal choice was fecal occult blood testing (59%); however, after exposure to test specific attributes, the modal choice was colonoscopy (54%). Conclusion: Participants were clear about the attributes that they prefer, but no single test has those attributes. Preferences were varied across participants and were not predictable; clinicians should discuss the full range of recommended tests for colorectal cancer with all patients.
KW - Colorectal neoplasms
KW - Decision making
KW - Ethnic groups
KW - Mass screening
KW - Patient preference
KW - Physician-patient communication
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U2 - 10.1370/afm.1054
DO - 10.1370/afm.1054
M3 - Article
C2 - 20212301
AN - SCOPUS:77949278271
SN - 1544-1709
VL - 8
SP - 141
EP - 150
JO - Annals of family medicine
JF - Annals of family medicine
IS - 2
ER -