Older adults' preferences for colorectal cancer-screening test attributes and test choice

Christine E Kistler; Thomas M Hess; Kirsten Howard; Michael P Pignone; Trisha M Crutchfield; Sarah T Hawley; Alison T Brenner; Kimberly T Ward; Carmen L Lewis

doi:10.2147/PPA.S82203

Older adults' preferences for colorectal cancer-screening test attributes and test choice

Patient Prefer Adherence. 2015 Jul 15:9:1005-16. doi: 10.2147/PPA.S82203. eCollection 2015.

Authors

Christine E Kistler¹, Thomas M Hess², Kirsten Howard³, Michael P Pignone⁴, Trisha M Crutchfield⁵, Sarah T Hawley⁶, Alison T Brenner⁷, Kimberly T Ward⁷, Carmen L Lewis⁸

Affiliations

¹ Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
² Department of Psychology, North Carolina State University, Raleigh, NC, USA.
³ Institute for Choice, University of South Australia, Sydney, NSW, Australia ; School of Public Health, University of Sydney, Sydney, NSW, Australia.
⁴ Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; Division of General Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
⁷ Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.

Abstract

Background: Understanding which attributes of colorectal cancer (CRC) screening tests drive older adults' test preferences and choices may help improve decision making surrounding CRC screening in older adults.

Materials and methods: To explore older adults' preferences for CRC-screening test attributes and screening tests, we conducted a survey with a discrete choice experiment (DCE), a directly selected preferred attribute question, and an unlabeled screening test-choice question in 116 cognitively intact adults aged 70-90 years, without a history of CRC or inflammatory bowel disease. Each participant answered ten discrete choice questions presenting two hypothetical tests comprised of four attributes: testing procedure, mortality reduction, test frequency, and complications. DCE responses were used to estimate each participant's most important attribute and to simulate their preferred test among three existing CRC-screening tests. For each individual, we compared the DCE-derived attributes to directly selected attributes, and the DCE-derived preferred test to a directly selected unlabeled test.

Results: Older adults do not overwhelmingly value any one CRC-screening test attribute or prefer one type of CRC-screening test over other tests. However, small absolute DCE-derived preferences for the testing procedure attribute and for sigmoidoscopy-equivalent screening tests were revealed. Neither general health, functional, nor cognitive health status were associated with either an individual's most important attribute or most preferred test choice. The DCE-derived most important attribute was associated with each participant's directly selected unlabeled test choice.

Conclusion: Older adults' preferences for CRC-screening tests are not easily predicted. Medical providers should actively explore older adults' preferences for CRC screening, so that they can order a screening test that is concordant with their patients' values. Effective interventions are needed to support complex decision making surrounding CRC screening in older adults.

Keywords: colorectal cancer screening; conjoint analysis; discrete choice experiment; patient preferences; test attributes; values clarification.

Grants and funding

K12 HS019468/HS/AHRQ HHS/United States