Journal of General Internal Medicine

, Volume 27, Issue 1, pp 45–50 | Cite as

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

  • Michael P. Pignone
  • Alison T. Brenner
  • Sarah Hawley
  • Stacey L. Sheridan
  • Carmen L. Lewis
  • Daniel E. Jonas
  • Kirsten Howard
Original Research



To compare two techniques for eliciting and clarifying patient values for decision making about colorectal cancer (CRC) screening: choice-based conjoint analysis and a rating and ranking task.


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 analysis-based most important attribute was determined from individual patient-level utilities generated using multinomial logistic regression and hierarchical Bayesian modeling.


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)


Choice-based conjoint analysis produced somewhat different patterns of attribute importance than a rating and ranking task, but had little effect on other outcomes.


colorectal cancer (CRC) screening conjoint analysis rating/ranking  preferences 

Supplementary material

11606_2011_1837_MOESM1_ESM.pdf (56 kb)
ESM 1(PDF 56 kb)


  1. 1.
    Braddock CH 3rd, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282(24):2313–20.PubMedCrossRefGoogle Scholar
  2. 2.
    Sheridan SL, Harris RP, Woolf SH. Shared Decision-Making Workgroup of the U.S. Preventive Services Task Force. Shared decision making about screening and chemoprevention. A suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med. 2004;26(1):56–66. PMID 14700714.PubMedCrossRefGoogle Scholar
  3. 3.
    O’Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2009;8(3):CD001431. Review PMID: 19588325.Google Scholar
  4. 4.
    Pignone M, Harris R, Kinsinger L. Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000;133(10):761–9. PMID: 11085838.PubMedGoogle Scholar
  5. 5.
    Elwyn G, O’Connor A, Stacey D, Volk R, Edwards A, Coulter A, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006;333(7565):417.PubMedCrossRefGoogle Scholar
  6. 6.
    O’Connor AM, Bennett C, Stacey D, Barry MJ, Col NF, Eden KB, et al. Do patient decision aids meet effectiveness criteria of the international patient decision aid standards collaboration? A systematic review and meta-analysis. Med Decis Mak. 2007;27(5):554–74. Epub 2007 Sep 14. Review PMID: 17873255.CrossRefGoogle Scholar
  7. 7.
    Elwyn G, O’Connor AM, Bennett C, Newcombe RG, Politi M, Durand MA, et al. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PLoS One. 2009;4(3):e4705. Epub 2009 Mar 4.PMID: 19259269.PubMedCrossRefGoogle Scholar
  8. 8.
    Ryan M, Gerard K. Using discrete choice experiments to value health care programmes: current practice and future research reflections. Appl Health Econ Health Policy. 2003;2(1):55–64.PubMedGoogle Scholar
  9. 9.
    Ryan M, Farrar S. Using conjoint analysis to elicit preferences for health care. BMJ. 2000;320:1530–1533.PubMedCrossRefGoogle Scholar
  10. 10.
    O’Connor AM, Wells GA, Tugwell P, Laupacis A, Elmslie T, Drake E. The effects of an ‘explicit’ values clarification exercise in a woman’s decision aid regarding postmenopausal hormone therapy. Health Expect. 1999;2(1):21–32. PMID: 11281872.PubMedCrossRefGoogle Scholar
  11. 11.
    Sheridan SL, Griffith J, Behrend L, Gizlice Z, Cai J, Pignone MP. Effect of adding a values clarification exercise to a decision aid on heart disease prevention: a randomized trial. Med Decis Mak. 2010;30(4):E28–39. Epub 2010 May 18. PMID: 20484089.CrossRefGoogle Scholar
  12. 12.
    Griffith JM, Lewis CL, Hawley S, Sheridan SL, Pignone MP. Randomized trial of presenting absolute v. relative risk reduction in the elicitation of patient values for heart disease prevention with conjoint analysis. Med Decis Mak. 2009;29(2):167–74. Epub 2009 Mar 11.PMID: 19279298.CrossRefGoogle Scholar
  13. 13.
    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. PMID: 18725820.PubMedCrossRefGoogle Scholar
  14. 14.
    Kim J, Whitney A, Hayter S, Lewis C, Campbell M, Sutherland L, et al. Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice. BMC Med Inform Decis Mak. 2005;28(5):36. PMID: 16313676.CrossRefGoogle Scholar
  15. 15.
    Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137(2):132–41. PMID: 12118972.PubMedGoogle Scholar
  16. 16.
    Pignone M, Saha S, Hoerger T, Mandelblatt J. Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137(2):96–104. PMID: 12118964.PubMedGoogle Scholar
  17. 17.
    Jonas DE, Russell LB, Sandler RS, Chou J, Pignone M. Patient time requirements for screening colonoscopy. Am J Gastroenterol. 2007;102(11):2401–10. Epub 2007 Jun 29. PMID: 17608779.PubMedCrossRefGoogle Scholar
  18. 18.
    Jonas DE, Russell LB, Sandler RS, Chou J, Pignone M. Value of patient time invested in the colonoscopy screening process: time requirements for colonoscopy study. Med Decis Mak. 2008;28(1):56–65. PMID: 18263561.CrossRefGoogle Scholar
  19. 19.
    Johnson RM, Orme BK. how many questions should you ask in choice-based conjoint studies? Sawtooth software research paper series 1996.Google Scholar
  20. 20.
    Barratt A, Howard K, Irwig L, Salkeld G, Houssami N. Model of outcomes of screening mammography: information to support informed choices. BMJ. 2005;23(330):7497–936. Epub 2005 Mar 8.PMID: 15755755.Google Scholar
  21. 21.
    Johnson R. Monotonicity constraints in choice-based conjoint with hierarchical Bayes Sawtooth software technical paper series 2000, available at
  22. 22.
    Bryan Orme, John Howell. Application of covariates within Sawtooth software’s CBC/HB program: theory and practical example. Sawtooth software technical paper series 2009, available at
  23. 23.
    Huber J. Achieving individual-level predictions from CBC data: comparing ICE and hierarchical bayes. Sawtooth technical paper series 1998, available at
  24. 24.
    Sheridan SL, Golin C, Harris RP, Driscoll D, Deal AM, Enemchukwu E, et al. A pilot randomized trial of two types of values clarification exercises to facilitate informed decision making for prostate cancer screening. Society of general internal medicine meeting (poster). Pittsburgh, PA. April 2008.Google Scholar
  25. 25.
    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. PMID: 17888107.PubMedCrossRefGoogle Scholar
  26. 26.
    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. Epub 2007 Dec 21.PubMedCrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Imaeda A, Bender D, Fraenkel L. What is most important to patients when deciding about colorectal screening? J Gen Intern Med. 2010;25(7):688–93. Epub 2010 Mar 23.PubMedCrossRefGoogle Scholar
  29. 29.
    Centers for Disease Control and Prevention (CDC). Vital signs: colorectal cancer screening among adults aged 50–75 years - United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(26):808–12. PubMed PMID: 20613704.Google Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Michael P. Pignone
    • 1
  • Alison T. Brenner
    • 1
  • Sarah Hawley
    • 2
  • Stacey L. Sheridan
    • 1
  • Carmen L. Lewis
    • 1
  • Daniel E. Jonas
    • 1
  • Kirsten Howard
    • 3
  1. 1.Department of Medicine, Cecil Sheps Center for Health Services Research and Lineberger Cancer CenterUniversity of North CarolinaChapel HillUSA
  2. 2.Department of MedicineUniversity of MichiganAnn ArborUSA
  3. 3.School of Public HealthUniversity of SydneySydneyAustralia

Personalised recommendations