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Assessing Stated Preferences for Colorectal Cancer Screening: A Critical Systematic Review of Discrete Choice Experiments

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Abstract

Background

It is well established that screening is effective in reducing the incidence and mortality associated with colorectal cancer (CRC). National screening programs have been implemented in many countries; however, uptake remains an issue. Understanding patient preferences may assist in shaping screening programs and tailoring information about screening tests.

Objective

Our objective was to undertake a systematic review of discrete choice experiments (DCEs) of CRC screening.

Methods

A systematic review of DCEs of CRC screening was undertaken in an average-risk general population. The methodological qualities of the studies were assessed using a standard checklist outlining best practice for conjoint studies.

Results

Nine studies met the selection criteria. Meta-analysis was not possible due to the heterogeneity of the data and methods. However, in eight studies, attributes describing accuracy and/or clinical effectiveness were reported to be statistically significant. We also found that individuals were willing to trade-off other attributes such as an increased risk of complications to gain greater clinical benefits. Screening was also preferred to non-screening by the majority of respondents, regardless of the test used.

Conclusions

Understanding and incorporating individuals’ preferences in decision making is increasingly considered essential in the health field. Data from DCEs can provide valuable insights into the trade-offs individuals are willing to undertake in respect to CRC screening. Such insights can be used by decision makers to identify screening tests that could maximize informed uptake. It is likely that, with better reporting and evolving methodology, the contribution that DCEs can make to such debates will increase.

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Acknowledgments

No conflicts of interest are declared for SW, GW, AK, or KH. Sally Wortley is being supported by an Australian Postgraduate Award (APA) scholarship.

Contributions

Sally Wortley is the main author of the paper and undertook the systematic review, data extraction, methodological assessment, and analysis of studies, as well as drafting the manuscript. Anh Kieu undertook data extraction, and both Germaine Wong and Anh Kieu reviewed and edited the paper. Kirsten Howard formally supervised the process and contributed to the analysis and interpretation, as well as providing guidance in the writing of the manuscript. Sally Wortley acts a guarantor of the content of the paper.

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Authors and Affiliations

  1. School of Public Health, University of Sydney, Camperdown, Australia

    S. Wortley, G. Wong & K. Howard

  2. Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, Australia

    G. Wong & A. Kieu

  3. Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia

    G. Wong

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  1. S. Wortley
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Correspondence to S. Wortley.

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Wortley, S., Wong, G., Kieu, A. et al. Assessing Stated Preferences for Colorectal Cancer Screening: A Critical Systematic Review of Discrete Choice Experiments. Patient 7, 271–282 (2014). https://doi.org/10.1007/s40271-014-0054-3

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