Patients Prioritize a Low-volume Bowel Preparation in Colitis-associated Colorectal Cancer Surveillance: A Discrete Choice Experiment

Anouk M Wijnands, Maarten Te Groen, Yonne Peters, Ad A Kaptein, Bas Oldenburg, Frank Hoentjen, Maurice W M D Lutgens, Anouk M Wijnands, Maarten Te Groen, Yonne Peters, Ad A Kaptein, Bas Oldenburg, Frank Hoentjen, Maurice W M D Lutgens

Abstract

Background: Patients with inflammatory bowel disease (IBD) undergo surveillance colonoscopies at fixed intervals to reduce the risk of colorectal cancer (CRC). Taking patients' preferences for determining surveillance strategies into account could improve adherence and patient satisfaction. This study aimed to determine patient preferences for CRC surveillance in IBD.

Methods: We conducted a web-based, multicenter, discrete choice experiment among adult IBD patients with an indication for surveillance. Individuals were repeatedly asked to choose between 3 hypothetical surveillance scenarios. The choice tasks were based on bowel preparation (0.3-4 L), CRC risk reduction (8% to 1%-6%), and interval (1-10 years). Attribute importance scores, trade-offs, and willingness to participate were calculated using a multinomial logit model. Latent class analysis was used to identify subgroups with similar preferences.

Results: In total, 310 of 386 sent out questionnaires were completed and included in the study. Bowel preparation was prioritized (attribute importance score 40.5%) over surveillance interval and CRC risk reduction (31.1% and 28.4%, respectively). Maximal CRC risk reduction, low-volume bowel preparation (0.3 L laxative with 2 L clear liquid) with 2-year surveillance was the most preferred combination. Three subgroups were identified: a "surveillance avoidant," "CRC risk avoidant," and "surveillance preferring" groups. Membership was correlated with age, educational level, perceived CRC risk, the burden of bowel preparation, and colonoscopies.

Conclusions: Inflammatory bowel disease patients consider bowel preparation as the most important element in acceptance of CRC surveillance. Heterogeneity in preferences was explained by 3 latent subgroups. These findings may help to develop an individualized endoscopic surveillance strategy in IBD patients.

Keywords: Crohn’s disease; risk perception; screening; ulcerative colitis.

© 2021 Crohn’s & Colitis Foundation. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Attribute importance scores for total sample (A) and latent classes (B), percentages. Importance scores displayed for the total sample (A) and each subgroup (B; in %). A higher score indicates a higher importance of the attribute for patients relative to the other attributes.
Figure 2.
Figure 2.
Part-worth utility scores (0-centered), total sample and latent classes. Part-worth utility scores indicate the relative preference of a level within the attribute, with lower scores indicating a less preferred level.

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Source: PubMed

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