Comparison of patient preferences for fecal immunochemical test or colonoscopy using the analytic hierarchy process

Yinghui Xu, Barcey T Levy, Jeanette M Daly, George R Bergus, Jeffrey C Dunkelberg, Yinghui Xu, Barcey T Levy, Jeanette M Daly, George R Bergus, Jeffrey C Dunkelberg

Abstract

Background: In average-risk individuals aged 50 to 75 years, there is no difference in life-years gained when comparing colonoscopy every 10 years vs. annual fecal immunochemical testing (FIT) for colorectal cancer screening. Little is known about the preferences of patients when they have experienced both tests.

Methods: The study was conducted with 954 patients from the University of Iowa Hospital and Clinics during 2010 to 2011. Patients scheduled for a colonoscopy were asked to complete a FIT before the colonoscopy preparation. Following both tests, patients completed a questionnaire which was based on an analytic hierarchy process (AHP) decision-making model.

Results: In the AHP analysis, the test accuracy was given the highest priority (0.457), followed by complications (0.321), and test preparation (0.223). Patients preferred colonoscopy (0.599) compared with FIT (0.401) when considering accuracy; preferred FIT (0.589) compared with colonoscopy (0.411) when considering avoiding complications; and preferred FIT (0.650) compared with colonoscopy (0.350) when considering test preparation. The overall aggregated priorities were 0.517 for FIT, and 0.483 for colonoscopy, indicating patients slightly preferred FIT over colonoscopy. Patients' preferences were significantly different before and after provision of detailed information on test features (p < 0.0001).

Conclusions: AHP analysis showed that patients slightly preferred FIT over colonoscopy. The information provided to patients strongly affected patient preference. Patients' test preferences should be considered when ordering a colorectal cancer screening test.

Figures

Figure 1
Figure 1
The structure of the Analytic Hierarchy Process model.
Figure 2
Figure 2
Participant enrollment flow chart.

References

    1. American Cancer Society . Cancer facts & figures 2013. Atlanta: American Cancer Society; 2013.
    1. Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116(3):544–73. doi: 10.1002/cncr.24760.
    1. Qaseem A, Denberg TD, Hopkins RH, Jr, Humphrey LL, Levine J, Sweet DE, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156(5):378–86. doi: 10.7326/0003-4819-156-5-201203060-00010.
    1. Rim SH, Joseph DA, Steele CB, Thompson TD, Seeff LC, Centers for Disease Control and Prevention (CDC) Colorectal cancer screening - United States, 2002, 2004, 2006, and 2008. MMWR Surveill Summ. 2011;60 Suppl:42–6.
    1. Hawley ST, McQueen A, Bartholomew LK, Greisinger AJ, Coan SP, Myers R, et al. Preferences for colorectal cancer screening tests and screening test use in a large multispecialty primary care practice. Cancer. 2012;118(10):2726–34. doi: 10.1002/cncr.26551.
    1. Wolf RL, Basch CE, Brouse CH, Shmukler C, Shea S. Patient preferences and adherence to colorectal cancer screening in an urban population. Am J Public Health. 2006;96(5):809–11. doi: 10.2105/AJPH.2004.049684.
    1. Meissner HI, Breen N, Klabunde CN, Vernon SW. Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiol Biomarkers Prev. 2006;15(2):389–94. doi: 10.1158/1055-9965.EPI-05-0678.
    1. Allison JE, Sakoda LC, Levin TR, Tucker JP, Tekawa IS, Cuff T, et al. Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics. J Natl Cancer Inst. 2007;99(19):1462–70. doi: 10.1093/jnci/djm150.
    1. van Rossum LG, van Rijn AF, Laheij RJ, van Oijen MG, Fockens P, van Krieken HH, et al. Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology. 2008;135(1):82–90. doi: 10.1053/j.gastro.2008.03.040.
    1. Telford JJ, Levy AR, Sambrook JC, Zou D, Enns RA. The cost-effectiveness of screening for colorectal cancer. CMAJ. 2010;182(12):1307–13. doi: 10.1503/cmaj.090845.
    1. Allison JE. FIT: a valuable but underutilized screening test for colorectal cancer-it’s time for a change. Am J Gastroenterol. 2010;105(9):2026–8. doi: 10.1038/ajg.2010.181.
    1. Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M, Kuntz KM. Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149(9):659–69. doi: 10.7326/0003-4819-149-9-200811040-00244.
    1. Centers for Disease Control and Prevention (CDC) Vital signs: colorectal cancer screening, incidence, and mortality–United States, 2002–2010. MMWR Morb Mortal Wkly Rep. 2011;60(26):884–9.
    1. Schroy PC, 3rd, Emmons KM, Peters E, Glick JT, Robinson PA, Lydotes MA, et al. Aid-assisted decision making and colorectal cancer screening: a randomized controlled trial. Am J Prev Med. 2012;43(6):573–83. doi: 10.1016/j.amepre.2012.08.018.
    1. Almog R, Ezra G, Lavi I, Rennert G, Hagoel L. The public prefers fecal occult blood test over colonoscopy for colorectal cancer screening. Eur J Cancer Prev. 2008;17(5):430–7. doi: 10.1097/CEJ.0b013e328305a0fa.
    1. Katsumura Y, Yasunaga H, Imamura T, Ohe K, Oyama H. Relationship between risk information on total colonoscopy and patient preferences for colorectal cancer screening options: analysis using the analytic hierarchy process. BMC Health Serv Res. 2008;8:106. doi: 10.1186/1472-6963-8-106.
    1. Dolan JG. Patient priorities in colorectal cancer screening decisions. Health Expect. 2005;8(4):334–44. doi: 10.1111/j.1369-7625.2005.00348.x.
    1. Dolan JG, Boohaker E, Allison J, Imperiale TF. Patients’ preferences and priorities regarding colorectal cancer screening. Med Decis Making. 2013;33(1):59–70. doi: 10.1177/0272989X12453502.
    1. Hummel JM, Steuten LG, Groothuis-Oudshoorn CJ, Mulder N, Ijzerman MJ. Preferences for colorectal cancer screening techniques and intention to attend: a multi-criteria decision analysis. Appl Health Econ Health Policy. 2013;11(5):499–507. doi: 10.1007/s40258-013-0051-z.
    1. Saaty TL. A scaling method for priorities in hierarchical structures. J Math Psychol. 1977;15(3):234–81. doi: 10.1016/0022-2496(77)90033-5.
    1. Saaty TL. The analytic hierarchy process: planning, priority setting, resource allocation. New York: McGraw; 1980.
    1. Sato Y. Comparison between multiple-choice and analytic hierarchy process: measuring human perception. Int Trans Oper Res. 2004;11(1):77–86. doi: 10.1111/j.1475-3995.2004.00441.x.
    1. Forman E, Peniwati K. Aggregating individual judgments and priorities with the Analytic Hierarchy Process. Eur J Oper Res. 1998;108(1):165–9. doi: 10.1016/S0377-2217(97)00244-0.
    1. Jones RM, Vernon SW, Woolf SH. Is discussion of colorectal cancer screening options associated with heightened patient confusion? Cancer Epidemiol Biomarkers Prev. 2010;19(11):2821–5. doi: 10.1158/1055-9965.EPI-10-0695.
    1. Whitaker R. Validation examples of the Analytic Hierarchy Process and Analytic Network Process. Math Comput Model. 2007;46(7–8):840–59. doi: 10.1016/j.mcm.2007.03.018.
    1. Ling BS, Moskowitz MA, Wachs D, Pearson B, Schroy PC. Attitudes toward colorectal cancer screening tests. J Gen Intern Med. 2001;16(12):822–30. doi: 10.1046/j.1525-1497.2001.10337.x.
    1. DeBourcy AC, Lichtenberger S, Felton S, Butterfield KT, Ahnen DJ, Denberg TD. Community-based preferences for stool cards versus colonoscopy in colorectal cancer screening. J Gen Intern Med. 2008;23(2):169–74. doi: 10.1007/s11606-007-0480-1.
    1. Hawley ST, Volk RJ, Krishnamurthy P, Jibaja-Weiss M, Vernon SW, Kneuper S. Preferences for colorectal cancer screening among racially/ethnically diverse primary care patients. Med Care. 2008;46(9 Suppl 1):S10–6. doi: 10.1097/MLR.0b013e31817d932e.
    1. Leard LE, Savides TJ, Ganiats TG. Patient preferences for colorectal cancer screening. J Fam Pract. 1997;45(3):211–8.
    1. Powell AA, Burgess DJ, Vernon SW, Griffin JM, Grill JP, Noorbaloochi S, et al. Colorectal cancer screening mode preferences among US veterans. Prev Med. 2009;49(5):442–8. doi: 10.1016/j.ypmed.2009.09.002.
    1. Inadomi JM, Vijan S, Janz NK, Fagerlin A, Thomas JP, Lin YV, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med. 2012;172(7):575–82. doi: 10.1001/archinternmed.2012.332.
    1. Schwartz B. The paradox of choice: why less is more. New York: Ecco; 2004.
    1. Grazzini G, Ventura L, Zappa M, Ciatto S, Confortini M, Rapi S, et al. Influence of seasonal variations in ambient temperatures on performance of immunochemical faecal occult blood test for colorectal cancer screening: observational study from the Florence district. Gut. 2010;59(11):1511–5. doi: 10.1136/gut.2009.200873.
    1. Deutekom M, van Rijn AF, Dekker E, Blaauwgeers H, Stronks K, Fockens P, et al. Uptake of faecal occult blood test colorectal cancer screening by different ethnic groups in the Netherlands. Eur J Public Health. 2009;19(4):400–2. doi: 10.1093/eurpub/ckp051.
    1. Halloran SP, Launoy G, Zappa M, International Agency for Research on Cancer European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Faecal occult blood testing. Endoscopy. 2012;44 Suppl 3:SE65–87.
    1. Young GP. Population-based screening for colorectal cancer: Australian research and implementation. J Gastroenterol Hepatol. 2009;24(Suppl 3):S33–42. doi: 10.1111/j.1440-1746.2009.06069.x.
    1. Marshall DA, Johnson FR, Phillips KA, Marshall JK, Thabane L, Kulin NA. Measuring patient preferences for colorectal cancer screening using a choice-format survey. Value Health. 2007;10(5):415–30. doi: 10.1111/j.1524-4733.2007.00196.x.
    1. Shokar NK, Carlson CA, Weller SC. Informed decision making changes test preferences for colorectal cancer screening in a diverse population. Ann Fam Med. 2010;8(2):141–50. doi: 10.1370/afm.1054.
    1. Griffith JM, Lewis CL, Brenner AR, Pignone MP. The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial. BMC Med Inform Decis Mak. 2008;8:4-6947-8-4.
    1. Pignone M, Bucholtz D, Harris R. Patient preferences for colon cancer screening. J Gen Intern Med. 1999;14(7):432–7. doi: 10.1046/j.1525-1497.1999.00018.x.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere