Purpose: To use conjoint valuation analysis to determine what individual demographic and psychosocial characteristics are related to an individual’s overall propensity for lung cancer screening among individuals at higher risk of lung cancer.
Method: A nationally representative internet-based survey of individuals at high risk of lung cancer due to a history of cigarette smoking was undertaken. The survey included a conjoint valuation exercise (CVE) which assessed preferences for lung cancer screening by having participants indicate likelihood of screening on a scale of 1-9 in 20 hypothetical scenarios. Attributes of the CVE scenarios were: out of pocket costs, mortality reduction from screening, healthcare provider recommendation, false positive rate, and convenience of screening. Average propensity to be screened (APS) was calculated as the mean of responses to the CVE items. Information was collected on: demographics, decisional conflict, screening pros and cons, social support for screening, cancer worry, perceived lung cancer risk, screening self-efficacy, and health risk preferences.
Result: The sample included 210 participants with an average age of 60.7±8.5, pack year smoking history of 40.0±20.1, 52% female, 25.1% African American, and 28.5% Hispanic. For a single question of interest in screening on a 1-5 scale, the average response was 2.80±1.26, and the average stated willingness to pay to be screened was $151±163. Overall APS was 3.85±1.71 with a range of 1.05-9.45. Individual scenarios had APS that ranged from 2.60±2.00 to 4.56±2.23. In univariate analyses, Blacks and those in an income category of $35,000-50,000 had significantly higher APS than did Whites and those in the lowest income category, respectively. In both univariate and multivariate analyses controlling for demographics, higher APS was significantly associated with: lower decisional conflict about screening: and higher scores on: screening benefits, social support for screening, lung cancer worry, perceived lung cancer risk, and screening self-efficacy.
Conclusion: Average propensity to be screened for lung cancer was fairly low in these individuals at higher risk for lung cancer. However, APS varied widely and was strongly associated with a number of individual characteristics. As lung cancer screening emerges as an evidence-based screening program for individuals at high risk, efforts to promote informed choices about screening will need to address known variability in demographic and psychosocial characteristics that may lead to both under and over-utilization of screening.
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