Patients’ Preferences and Priorities Regarding Colorectal Cancer Screening

Abstract

Background US colorectal cancer screening guidelines for people at average risk for colorectal cancer endorse multiple screening options and recommend that screening decisions reflect individual patient preferences. Methods We used the Analytic Hierarchy Process (AHP) to ascertain decision priorities of people at average risk for colorectal cancer attending primary care practices in Rochester NY, Birmingham AL, and Indianapolis IN. The analysis included four decision criteria, three sub-criteria, and ten options. Results 484 people completed the study; 66% were female, 49% were African-American, 9% had low literacy skills, and 27% had low numeracy skills. Overall, preventing cancer was given the highest priority (mean priority 55%), followed by avoiding screening test side effects (mean priority 17%), minimizing false positive test results (mean priority 15%), and the combined priority of screening frequency, test preparation, and the test procedure(s) (mean priority 14%). Hierarchical cluster analysis revealed six distinct priority groupings containing multiple instances of decision priorities that differed from the average value by a factor of four or more. More than 90% of the study participants fully understood the concepts involved, 79% met AHP analysis quality standards, and 88% were willing to use similar methods to help make important healthcare decisions. Conclusion These results highlight the need to facilitate incorporation of patient preferences into colorectal cancer screening decisions. The large number of study participants able and willing to perform the complex AHP analysis used for this study suggests that the AHP is a useful tool for identifying the patient-specific priorities needed to ensure that screening decisions appropriately reflect individual patient preferences.

Group Decision Making with the Analytic Hierarchy Process in Benefit-Risk Assessment: A Tutorial

“…It can support individual decision makers, as well as groups of decision makers [3]. The AHP aims to support shared decision making [4,5], decisions on clinical guidelines [6,7], decisions on the development of new technology [8,9], organizational decisions [10,11], and decisions on health policy [12][13][14], such as regulatory decisions, reimbursement decisions, or allocation of public research funding.…”

Diagnosis of Periprosthetic Joint Infection in Medicare Patients: Multicriteria Decision Analysis

“…In regard to the method used to create the prioritization of diagnostic strategies, the analytic hierarchy process is not the only method of MCDA and the use of different methods can modify the presented results. Concerning the limited number of decision makers, we chose analytic hierarchy process for its adaptability to different decision makers' requirements (flexibility), ease of use, and strength of measurement [9]. Our intention is to promote the replication of this study by other researchers around the world to generate their own priorities according to local available resources and patient populations while targeting the same MSIS diagnostic criteria [21].…”

“…1). Dolan et al [9] summarized it in five steps: (1) create a decision model by defining the decision goal, the options, and the criteria that will be used to determine how well the options meet the goal; (2) judge how well the options satisfy each criterion by making a series of pairwise comparisons among them using a 9-point scale ranging from equally good to extremely better or by incorporating the direct weight of the priorities (the different priorities must sum to 1.00) (we used both methods); (3) determine the relative priorities of the criteria in meeting the decision goal by making a series of pairwise comparisons among them using a 9-point scale ranging from equally important to extremely more important or incorporating the direct weight of the priorities (the different priorities must sum to 1.00); (4) combine the option judgments and the criteria priorities to create a numeric ratio scale that indicates how well the options meet the goal; and (5) if desired, perform sensitivity analysis to explore the effects of changing the option judgments, criteria priorities, or both. The measurement utilized to compare the different options is called the total score.…”

“…The analytic hierarchy process is the most frequently used method of MCDA for medical decision support [9]. It allows the decision maker to design a hierarchical structure and evaluate the trade-offs between decision criteria and alternatives, thus facilitating improved clinical and management decisions [27].…”

Surgical Approaches for Cam Femoroacetabular Impingement: The Use of Multicriteria Decision Analysis

“…Evidence-based, patient-centered clinical decision-making is composed of all of these features [12]. Analytic hierarchical process (AHP), the most frequently used method of MCDA for medical decision support [11], allows the decision-maker to design a hierarchical structure and weigh the tradeoffs between decision criteria and alternatives to facilitate improved clinical and management decisions [35] (Fig. 1).…”