Informed decision making changes test preferences for colorectal cancer screening in a diverse population

Navkiran K. Shokar, Carol A. Carlson, Susan Weller

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)141-150
Number of pages10
JournalAnnals of Family Medicine
Volume8
Issue number2
DOIs
StatePublished - Mar 2010

Fingerprint

Early Detection of Cancer
Patient Preference
Colorectal Neoplasms
Decision Making
Occult Blood
Colonoscopy
Population
Colon
Sigmoidoscopy
Primary Health Care
Communication

Keywords

  • Colorectal neoplasms
  • Decision making
  • Ethnic groups
  • Mass screening
  • Patient preference
  • Physician-patient communication

ASJC Scopus subject areas

  • Family Practice

Cite this

Informed decision making changes test preferences for colorectal cancer screening in a diverse population. / Shokar, Navkiran K.; Carlson, Carol A.; Weller, Susan.

In: Annals of Family Medicine, Vol. 8, No. 2, 03.2010, p. 141-150.

Research output: Contribution to journalArticle

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abstract = "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.",
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