Preferences for Colorectal Cancer Screening Among Racially/Ethnically Diverse Primary Care Patients

Hawley, Sarah T.; Volk, Robert J.; Krishnamurthy, Partha; Jibaja‐Weiss, Maria; Vernon, Sally W.; Kneuper, Suzanne

doi:10.1097/mlr.0b013e31817d932e

Cited by 136 publications

(154 citation statements)

References 36 publications

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“…24 Although we are not aware of other published studies that have compared different methods of values elicitation for CRC screening, several have used explicit techniques to assess key decisional attributes. 13,[25][26][27][28] (Details of these studies are provided in Appendix 5-available online) Most studies have found test accuracy (ability to detect cancer and polyps) to be the most common most important attribute, but the order of importance of other attributes has varied considerably across studies.…”

Section: Discussionmentioning

confidence: 99%

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Conjoint Analysis Versus Rating and Ranking for Values Elicitation and Clarification in Colorectal Cancer Screening

et al. 2011

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PURPOSE:To compare two techniques for eliciting and clarifying patient values for decision making about colorectal cancer (CRC) screening: choicebased conjoint analysis and a rating and ranking task. METHODS: Using our decision lab registry and university e-mail lists, we recruited average risk adults ages 48-75 for a written, mailed survey. Eligible participants were given basic information about CRC screening and six attributes of CRC screening tests, then randomized to complete either a choice-based conjoint analysis with 16 discrete choice tasks or a rating and ranking task. The main outcome was the most important attribute, as determined from conjoint analysis or participant ranking. Conjoint analysisbased most important attribute was determined from individual patient-level utilities generated using multinomial logistic regression and hierarchical Bayesian modeling. RESULTS: Of the 114 eligible participants, 104 completed and returned questionnaires. Mean age was 57 (range 48-73), 70% were female, 88% were white, 71% were college graduates, and 62% were up to date with CRC screening. Ability to reduce CRC incidence and mortality was the most frequent most important attribute for both the conjoint analysis (56% of respondents) and rating/ranking (76% of respondents) groups, and these proportions differed significantly between groups (absolute difference 20%, 95% CI 3%, 37%, p =0.03). There were no significant differences between groups in proportion with clear values (p = 0.352), intent to be screened (p = 0.226) or unlabelled test preference (p=0.521) CONCLUSIONS: Choice-based conjoint analysis produced somewhat different patterns of attribute importance than a rating and ranking task, but had little effect on other outcomes.

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Section: Discussionmentioning

confidence: 99%

“…13,14 These attributes were used for both the choice-based conjoint analysis tasks and rating and ranking tasks.…”

Section: Development Of Attributesmentioning

confidence: 99%

Conjoint Analysis Versus Rating and Ranking for Values Elicitation and Clarification in Colorectal Cancer Screening

et al. 2011

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“…[14][15][16] Furthermore, when these discussions are held, primary care physicians routinely recommend colonoscopy as their preferred test and rarely mention other tests. [17][18][19] Recent research, however, demonstrates that providing patients a choice of screening options may increase CRC screening completion, particularly among racial and ethnic minorities. 20 We conducted a quasi-experimental trial to evaluate and compare the effectiveness of a physician-only and a physician-patient intervention on physicians' recommendations for CRC screening and actual rates of screening.…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of a Physician-Only and Physician–Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients

et al. 2015

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BACKGROUND: Physician recommendation of colorectal cancer (CRC) screening is a critical facilitator of screening completion. Providing patients a choice of screening options may increase CRC screening completion, particularly among racial and ethnic minorities. OBJECTIVE: Our purpose was to assess the effectiveness of physician-only and physician-patient interventions on increasing rates of CRC screening discussions as compared to usual care. DESIGN: This study was quasi-experimental. Clinics were allocated to intervention or usual care; patients in intervention clinics were randomized to receipt of patient intervention. PARTICIPANTS: Patients aged 50 to 75 years, due for CRC screening, receiving care at either a federally qualified health care center or an academic health center participated in the study. INTERVENTION: Intervention physicians received continuous quality improvement and communication skills training. Intervention patients watched an educational video immediately before their appointment. MAIN MEASURES: Rates of patient-reported 1) CRC screening discussions, and 2) discussions of more than one screening test. KEY RESULTS: The physician-patient intervention (n=167) resulted in higher rates of CRC screening discussions compared to both physician-only intervention (n=183; 61.1 % vs.50.3 %, p=0.008) and usual care (n=153; 61.1 % vs. 34.0 % p=0.03). More discussions of specific CRC screening tests and discussions of more than one test occurred in the intervention arms than in usual care (44.6 % vs. 22.9 %,p=0.03) and (5.1 % vs. 2.0 %, p=0.036), respectively, but discussion of more than one test was uncommon. Across all arms, 143 patients (28.4 %) reported discussion of colonoscopy only; 21 (4.2 %) reported discussion of both colonoscopy and stool tests. CONCLUSIONS:Compared to usual care and a physician-only intervention, a physician-patient intervention increased rates of CRC screening discussions, yet discussions overwhelmingly focused solely on colonoscopy. In underserved patient populations where access to colonoscopy may be limited, interventions encouraging discussions of both stool tests and colonoscopy may be needed.KEY WORDS: colorectal cancer screening; health literacy; randomized trial; physician communication of preventive care.

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“…Extending this assumption to health behavior, if there is variation in preferences regarding the most desirable attributes of a product or service across individuals and these attributes can be varied across products or services, then offering a wide variety of products or services (representing a range of potentially desirable attributes) will be preferable because it will increase the likelihood that each individual will find and act on an option that satisfies his or her unique preferences. Studies comparing preferences for four or more recommended CRC screening options do suggest there is variation in mode preferences and the value patients assign to attributes related to preferences 11,[19][20][21][22][23][24][25] . However, evidence that the vast majority of patients prefer either FOBT or colonoscopy [20][21][22][23]25 calls into question the value of investing in the more rarely preferred screening modalities, particularly in settings where high adherence rates have already been achieved using a screening approach emphasizing a single mode [26][27][28] .…”

Section: Introductionmentioning

confidence: 99%

Bringing an Organizational Perspective to the Optimal Number of Colorectal Cancer Screening Options Debate

et al. 2011

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Improving colorectal cancer (CRC) screening rates represents a challenge for primary care providers. Some have argued that offering a choice of CRC screening modes to patients will improve the currently low adherence rates. Others have raised concerns that offering numerous CRC screening options in practice could overwhelm patients and thus dampen enthusiasm for screening. In this article we assemble evidence to critically evaluate the relative merit of these opposing views. We find little evidence to support the hypothesis that the number of options offered will affect adherence (either positively or negatively), or that expanding the modalities offered beyond FOBT and colonoscopy will improve patient satisfaction. Therefore, we assert future decisions about the number of CRC screening modes to offer would more productively be focused on considerations such as what benefit the health-care organization would derive from offering additional modes, and how this change would affect other critical components of a successful screening program such as timely diagnosis. In light of these organizational level considerations, we agree with the assertion made by others that a screening program limited to FOBT and colonoscopy is likely to be ideal in most settings.KEY WORDS: colorectal neoplasms; mass screening; choice behavior; decision making; organizational decision making.

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Preferences for Colorectal Cancer Screening Among Racially/Ethnically Diverse Primary Care Patients

Cited by 136 publications

References 36 publications

Conjoint Analysis Versus Rating and Ranking for Values Elicitation and Clarification in Colorectal Cancer Screening

Conjoint Analysis Versus Rating and Ranking for Values Elicitation and Clarification in Colorectal Cancer Screening

The Effectiveness of a Physician-Only and Physician–Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients

Bringing an Organizational Perspective to the Optimal Number of Colorectal Cancer Screening Options Debate

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