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Keywords:

  • colorectal neoplasms prevention and control;
  • decision support techniques;
  • practice guidelines;
  • shared decision making

Abstract

Background  Colorectal cancer screening guidelines in the United States recommend that decisions about screening should incorporate patient preferences, but little is known about how patients make the trade-offs inherent in choosing one of the five currently recommended screening programmes.

Study population  Forty-eight primary care patients at average risk for colorectal cancer who completed an experimental shared decision-making intervention based on a multicriteria decision analysis.

Methods  Descriptive analysis of priorities assigned to decision criteria describing the advantages and disadvantages of the five currently recommended colorectal screening programmes in the United States. Criteria were divided into four major criteria – avoid cancer, avoid screening side-effects, avoid false positive test results and the combined importance of other considerations – and three subcriteria: the number of screening tests, test preparation and the test itself. Cluster analysis was used to identify common combinations of priorities within each set of criteria.

Results  Patients assigned widely variable priorities to both the criteria and subcriteria: the average range of priorities was 46 on a 100 point priority scale. Cluster analysis identified six different combinations of priorities for the major criteria and four for the subcriteria. The differences in priorities assigned to both the criteria and subcriteria in the clusters were statistically significant with P < 0.0001.

Conclusions  Even within a small group of patients, preferences vary widely regarding trade-offs involved in choosing among the currently recommended colorectal cancer screening programmes in the United States. These results provide empiric support for recommendations to utilize a shared decision-making process when making colorectal cancer screening decisions and highlight the need for additional research into how average risk patients view the trade-offs inherent in choosing a colorectal cancer screening programme.