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

Abstract

Christine E Kistler,1–3 Thomas M Hess,4 Kirsten Howard,5,6 Michael P Pignone,2,3,7 Trisha M Crutchfield,2,3,8 Sarah T Hawley,9 Alison T Brenner,2 Kimberly T Ward,2 Carmen L Lewis10 1Department of Family Medicine, School of Medicine, 2Cecil G Sheps Center for Health Services Research, 3Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, 4Department of Psychology, North Carolina State University, Raleigh, NC, USA; 5Institute for Choice, University of South Australia, Sydney, NSW, Australia; 6School of Public Health, University of Sydney, Sydney, NSW, Australia; 7Division of General Internal Medicine, School of Medicine, 8Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, 9Department of Medicine, University of Michigan, Ann Arbor, MI, 10Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA 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, patient preferences, values clarification, discrete choice experiment, conjoint analysis, test attributes