Purpose: US colorectal cancer screening guidelines endorse multiple options and recommend that screening decisions reflect individual patient preferences. A recent NIH consensus panel identified achieving a better understanding of patient preferences regarding colorectal cancer screening as a high priority topic. The study goal was to elicit and examine patient priorities for trade-offs involved in choosing among currently recommended colorectal cancer screening options.
Methods: The study population consisted of patients attending primary care practices in Rochester NY, Birmingham AL, and Indianapolis IN. Study participants used the Analytic Hierarchy Process (AHP) to analyze ten alternatives that represent the full range of currently recommended colorectal cancer screening options. The analysis included four decision criteria: prevent cancer, avoid screening side effects, minimize false positive screening tests, and the combined importance of frequency of testing, test preparation, and screening procedure. All patients performed the analysis using age-adjusted outcome estimates and a standardized computer program running on a laptop computer.
Results: Four hundred eighty four patients 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 score 55%). Hierarchical cluster analysis revealed six distinct priority clusters. Preventing cancer was the highest priority criterion in 3 clusters; each of the other 3 criteria was the highest priority criterion in one of the other 3 clusters. Seventy-nine percent of patients achieved technically adequate analyses. Technical adequacy was associated with patient gender (p = 0.008) and study site (p < 0.001) but not literacy or numeracy. More than 90% of study participants indicated that they fully understood the concepts involved and 88% indicated they were willing to use similar methods to help them make important healthcare decisions.
Conclusions: These results highlight the need to develop tools to facilitate incorporation of patient preferences into screening decisions. The large number of patients able and willing to perform a complex AHP analysis suggests that highly sophisticated decision support tools like the AHP are feasible for clinical use. Such tools have the potential to foster consistently high quality decision-making regarding colorectal cancer screening and other choices that depend on the successful integration of objective data, subjective judgments, and personal preferences.