Eliciting Population Preferences for Mass Colorectal Cancer Screening Organization

Nayaradou, Maximilien; Berchi, Célia; Dejardin, Olivier; Launoy, Guy

doi:10.1177/0272989x09342747

Cited by 39 publications

(56 citation statements)

References 28 publications

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“…Patients undergoing colonoscopy were less satisfied than those undergoing CT colonography (median score of 61 and interquartile range [IQR] of 55-67 vs median score of 64 and IQR of 58-70, respectively; P = .008) and significantly more worried (median score of 16 [IQR,[12][13][14][15][16][17][18][19][20][21] vs 15 [IQR, [9][10][11][12][13][14][15][16][17][18][19], P = .007); they also experienced more physical discomfort (median score of 39 [IQR, 29-51] vs 35 [IQR,) and more adverse events (82 of 246 vs 28 of 122 reported feeling faint or dizzy, P = .039). However, at 3 months, they were more satisfied with how results were received (median score of 4 [IQR, [3][4] vs 3 [IQR, , P , .0005) and less likely to require follow-up colonic investigations (17 of 230 vs 37 of 107, P , .0005).…”

Section: Resultsmentioning

confidence: 99%

“…Previous research has shown sensitivity to be important when patients form preferences for colorectal investigations, both in diagnostic (19) and screening (20)(21)(22) contexts. It is possible that participants would rate CT colonography less positively if aware that it may be less sensitive than colonoscopy (23).…”

Section: Gastrointestinal Imaging: Patient Experience With Colonic Exmentioning

confidence: 99%

See 1 more Smart Citation

Patient Acceptability and Psychologic Consequences of CT Colonography Compared with Those of Colonoscopy: Results from a Multicenter Randomized Controlled Trial of Symptomatic Patients

Wagner

Ghanouni²,

Halligan³

et al. 2012

Radiology

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For the SIGGAR Investigators Purpose:To use a randomized design to compare patients' short-and longer-term experiences after computed tomographic (CT) colonography or colonoscopy. Materials and Methods:After ethical approval, the trial was registered. Patients gave written informed consent. Five hundred forty-seven patients with symptoms suggestive of colorectal cancer who had been randomly assigned at a ratio of 2:1 to undergo either colonoscopy (n = 362) or CT colonography (n = 185) received a validated questionnaire to assess immediate test experience (including satisfaction, worry, discomfort, adverse effects) and a 3-month questionnaire to assess psychologic outcomes (including satisfaction with result dissemination and reassurance). Data were analyzed by using Mann-Whitney U, Kruskal-Wallis, and x 2 test statistics. Results:Patients undergoing colonoscopy were less satisfied than those undergoing CT colonography (median score of 61 and interquartile range [IQR] of 55-67 vs median score of 64 and IQR of 58-70, respectively; P = .008) and significantly more worried (median score of 16 [IQR,[12][13][14][15][16][17][18][19][20][21] vs 15 [IQR,[9][10][11][12][13][14][15][16][17][18][19], P = .007); they also experienced more physical discomfort (median score of 39 [IQR, vs 35 [IQR,) and more adverse events (82 of 246 vs 28 of 122 reported feeling faint or dizzy, P = .039). However, at 3 months, they were more satisfied with how results were received (median score of 4 [IQR,[3][4], P , .0005) and less likely to require follow-up colonic investigations (17 of 230 vs 37 of 107, P , .0005). No differences were observed between the tests regarding 3-month psychologic consequences of the diagnostic episode, except for a trend toward a difference (P = .050) in negative affect (unpleasant emotions such as distress), with patients undergoing CT colonography reporting less intense negative affect.

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Section: Resultsmentioning

confidence: 99%

Section: Gastrointestinal Imaging: Patient Experience With Colonic Exmentioning

confidence: 99%

Patient Acceptability and Psychologic Consequences of CT Colonography Compared with Those of Colonoscopy: Results from a Multicenter Randomized Controlled Trial of Symptomatic Patients

Wagner

Ghanouni²,

Halligan³

et al. 2012

Radiology

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“…Previous research has found sensitivity to be important when patients form preferences for colorectal investigations, both in symptomatic 78 and screening contexts. [101][102][103] It is possible that participants would rate CTC less positively if aware that it may be less sensitive than colonoscopy. 15 Observations may also have been influenced by centre-to-centre variation in bowel preparation, sedation/analgesia and gas insufflation.…”

Section: Health Psychology Assessmentmentioning

confidence: 99%

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Halligan

Dadswell

Wooldrage

et al. 2015

Health Technol Assess

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BackgroundComputed tomographic colonography (CTC) is a relatively new diagnostic test that may be superior to existing alternatives to investigate the large bowel.ObjectivesTo compare the diagnostic efficacy, acceptability, safety and cost-effectiveness of CTC with barium enema (BE) or colonoscopy.DesignParallel randomised trials: BE compared with CTC and colonoscopy compared with CTC (randomisation 2 : 1, respectively).SettingA total of 21 NHS hospitals.ParticipantsPatients aged ≥ 55 years with symptoms suggestive of colorectal cancer (CRC).InterventionsCTC, BE and colonoscopy.Main outcome measuresFor the trial of CTC compared with BE, the primary outcome was the detection rate of CRC and large polyps (≥ 10 mm), with the proportion of patients referred for additional colonic investigation as a secondary outcome. For the trial of CTC compared with colonoscopy, the primary outcome was the proportion of patients referred for additional colonic investigation, with the detection rate of CRC and large polyps as a secondary outcome. Secondary outcomes for both trials were miss rates for cancer (via registry data), all-cause mortality, serious adverse events, patient acceptability, extracolonic pathology and cost-effectiveness.ResultsA total of 8484 patients were registered and 5384 were randomised and analysed (BE trial: 2527 BE, 1277 CTC; colonoscopy trial: 1047 colonoscopy, 533 CTC). Detection rates in the BE trial were 7.3% (93/1277) for CTC, compared with 5.6% (141/2527) for BE (p = 0.0390). The difference was due to better detection of large polyps by CTC (3.6% vs. 2.2%;p = 0.0098), with no significant difference for cancer (3.7% vs. 3.4%;p = 0.66). Significantly more patients having CTC underwent additional investigation (23.5% vs. 18.3%;p = 0.0003). At the 3-year follow-up, the miss rate for CRC was 6.7% for CTC (three missed cancers) and 14.1% for BE (12 missed cancers). Significantly more patients randomised to CTC than to colonoscopy underwent additional investigation (30% vs. 8.2%;p < 0.0001). There was no significant difference in detection rates for cancer or large polyps (10.7% for CTC vs. 11.4% for colonoscopy;p = 0.69), with no difference when cancers (p = 0.94) and large polyps (p = 0.53) were analysed separately. At the 3-year follow-up, the miss rate for cancer was nil for colonoscopy and 3.4% for CTC (one missed cancer). Adverse events were uncommon for all procedures. In 1042 of 1748 (59.6%) CTC examinations, at least one extracolonic finding was reported, and this proportion increased with age (p < 0.0001). A total of 149 patients (8.5%) were subsequently investigated, and extracolonic neoplasia was diagnosed in 79 patients (4.5%) and malignancy in 29 (1.7%). In the short term, CTC was significantly more acceptable to patients than BE or colonoscopy. Total costs for CTC and colonoscopy were finely balanced, but CTC was associated with higher health-care costs than BE. The cost per large polyp or cancer detected was £4235 (95% confidence interval £395 to £9656).ConclusionsCTC is superior to BE for detection of cancers and large polyps in symptomatic patients. CTC and colonoscopy detect a similar proportion of large polyps and cancers and their costs are also similar. CTC precipitates significantly more additional investigations than either BE or colonoscopy, and evidence-based referral criteria are needed. Further work is recommended to clarify the extent to which patients initially referred for colonoscopy or BE undergo subsequent abdominopelvic imaging, for example by computed tomography, which will have a significant impact on health economic estimates.Trial registrationCurrent Controlled Trials ISRCTN95152621.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 54. See the NIHR Journals Library website for further project information. Funding was also provided by the UK Department of Health, which stipulated a randomised controlled design but had no involvement in the collection, analysis or interpretation of data, in writing the report, or in the decision to submit for publication. This was also the case for manufacturers who donated equipment for the study (Bracco UK Ltd, High Wycombe, UK; Viatronix Inc., Stony Brook, NY, USA; Medicsight plc, London, UK; Barco Ltd, Bracknell, UK).

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“…the period between screening invitations), CRC mortality risk reduction, test specificity (the proportion of people without abnormalities who are correctly categorised as such) and financial costs [24]. Other perspectives included improving service users' satisfaction [19] or fulfilling an ethical duty to involve service users in healthcare decisions [23].…”

Section: Study Aims and Perspectivesmentioning

confidence: 99%

“…sensitivity, "unnecessary colonoscopies" or "accuracy" [21][22][23]) or CRCmortality risk reduction [18,20]). Two studies provided information on both accuracy and CRC-mortality risk reduction [19,23].…”

Section: Attributes and Levelsmentioning

confidence: 99%

Public preferences for colorectal cancer screening tests: a review of conjoint analysis studies

Ghanouni

Smith

Halligan

et al. 2013

Expert Review of Medical Devices

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A wide range of screening technologies is available for colorectal cancer (CRC) screening. There is demand to discover public preferences for these tests on the rationale that tailoring screening to preferences may improve uptake. This review describes a type of study (conjoint analysis) used to assess people's preferences for CRC screening tests and critically evaluates research quality using a recently published set of guidelines. Most primary studies assessed preferences for colonoscopy and faecal occult blood testing but newer technologies (e.g. capsule endoscopy) have not yet been evaluated. Although studies often adhered to guidelines, there was limited correspondence between stated preferences and actual screening behaviour. Future research should investigate how studies can go beyond the guidelines in order to improve this and also explore how test preferences may differ by important population subgroups.

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Eliciting Population Preferences for Mass Colorectal Cancer Screening Organization

Cited by 39 publications

References 28 publications

Patient Acceptability and Psychologic Consequences of CT Colonography Compared with Those of Colonoscopy: Results from a Multicenter Randomized Controlled Trial of Symptomatic Patients

Patient Acceptability and Psychologic Consequences of CT Colonography Compared with Those of Colonoscopy: Results from a Multicenter Randomized Controlled Trial of Symptomatic Patients

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Public preferences for colorectal cancer screening tests: a review of conjoint analysis studies

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