Colorectal cancer screening preferences among physicians and individuals at average risk: A discrete choice experiment

Abstract

Background: Guidelines include several options for average-risk colorectal cancer (CRC) screening that vary in aspects such as invasiveness, recommended frequency, and precision. Thus, patient and provider preferences can help identify an appropriate screening strategy. This study elicited CRC screening preferences of physicians and individuals at average risk for CRC (IAR).Methods: IAR aged 45-75 years and licensed physicians (primary care or gastroenterology) completed an online discrete choice experiment (DCE). Participants were recruited from representative access panels in the US. Within the DCE, participants traded off preferences between screening type, screening frequency, true-positive, true-negative, and adenoma true positive (physicians only). A mixed logit model was used to obtain predicted choice probabilities for colonoscopy, multi-target stool DNA (mt-sDNA), fecal immunochemical test (FIT), and methylated septin 9 (mSEPT9) blood test.Results: Preferences of IAR and physicians were affected by screening precision and screening type. IAR also valued more regular screening. Physicians preferred colonoscopy (96.8%) over mt-sDNA (2.8%; p < 0.001), FIT (0.3%; p < 0.001) and mSEPT9 blood test (0.1%; p < 0.01). IAR preferred mt-sDNA (38.8%) over colonoscopy (32.5%; p < 0.001), FIT (19.2%; p < 0.001), and mSEPT9 blood test (9.4%; p < 0.001). IAR naïve to screening preferred non-invasive screening (p < 0.001), while the opposite was found for those who previously underwent colonoscopy or sigmoidoscopy.Conclusions: While physicians overwhelmingly preferred colonoscopy, preferences of IAR were heterogenous, with mt-sDNA being most frequently preferred on average. Offering choices in addition to colonoscopy could improve CRC screening uptake among IAR.

Colorectal cancer screening

“…6 These findings suggest that giving patients options about a preferred screening method could enhance adherence and improve screening rates. 6,31 CONCLUSION CRC is the third leading cause of cancer-related death in the United States, with more than 150,000 cases expected in 2023. 1 Screening guidelines have been updated to address the fact that nearly 11% of cases are discovered in patients under age 50 years.…”

“…6 Patients preferred MT-sDNA (38.8%) over colonoscopy (32.5%), and FIT (19.2%), still valuing precision but also driven by preferring screenings more frequently than every 10 years. 6 Although physicians overwhelmingly prefer colonoscopy, most patients, particularly hesitant, treatment-naive patients, prefer MT-sDNA. 6 These findings suggest that giving patients options about a preferred screening method could enhance adherence and improve screening rates.…”

“…6 Although physicians overwhelmingly prefer colonoscopy, most patients, particularly hesitant, treatment-naive patients, prefer MT-sDNA. 6 These findings suggest that giving patients options about a preferred screening method could enhance adherence and improve screening rates. 6,31 CONCLUSION CRC is the third leading cause of cancer-related death in the United States, with more than 150,000 cases expected in 2023.…”

“…3,32 However, traditional screening methods such as FIT and colonoscopy have not achieved the 80% target rate endorsed by the National Colorectal Cancer Round Table. 6 Colonoscopy, an effective diagnostic and therapeutic option, remains the gold standard, but screening rates have not reached target levels because of cost concerns, unpleasant preparation, risks inherent to an invasive procedure, and access issues. 4 Novel screening methods, including MT-sDNA, offer options to increase screening while potentially mitigating the inherent risks and high costs associated with colonoscopy.…”

“…19 Patient preference for MT-sDNA exceeds that for colonoscopy or FIT. 6 MT-sDNA is a valuable screening option that is not meant to replace colonoscopy but rather serve as an alternative to improve screening rates, especially among average-risk patients who encounter barriers to colonoscopy. By offering options to patients, clinicians may be able to improve CRC screening and detection rates and reduce the morbidity and mortality associated with CRC.…”