Sydney School of Public Health, University of Sydney, Sydney, Australia.
Value Health. 2011 Dec;14(8):1146-52. doi: 10.1016/j.jval.2011.07.012.
Computed tomography colonography (CTC) is an alternative diagnostic test to colonoscopy for colorectal cancer and polyps. The aim of this study was to determine test characteristics important to patients and to examine trade-offs in attributes that patients are willing to accept in the context of the diagnosis of colorectal cancer.
A discrete choice study was used to assess preferences of patients with clinical indications suspicious of colorectal cancer who experienced both CTC and colonoscopy as part of a diagnostic accuracy study in South Australia. Results were analyzed by using a mixed logit model and presented as odds ratios (ORs) for preferring CTC over colonoscopy.
Colonoscopy was preferred over CTC as the need for a second procedure after CTC increased (OR of preferring CTC to colonoscopy = 0.013), as the likelihood of missing cancers or polyps increased (OR of preferring CTC to colonoscopy = 0.62), and as CTC test cost increased (OR of preferring CTC to colonoscopy = 0.65-0.80). CTC would be preferred to colonoscopy if a minimal bowel preparation was available (OR = 1.7). Some patients were prepared to trade off the diagnostic and therapeutic advantage of colonoscopy for a CTC study with a less intensive bowel preparation. Preferences also varied significantly with sociodemographic characteristics.
Despite CTC's often being perceived as a preferred test, this may not always be the case. Informed decision making for diagnostic tests for colorectal cancer should include discussion of the benefits, downsides, and uncertainties associated with alternative tests, as patients are willing and able to make trade-offs between what they perceive as the advantages and disadvantages of these diagnostic tests.
计算机断层结肠成像（CTC）是结直肠癌和息肉的替代诊断测试。本研究旨在确定对患者重要的测试特征，并研究患者在结直肠癌诊断背景下愿意接受的属性之间的权衡。
采用离散选择研究评估了南澳大利亚一项诊断准确性研究中患有疑似结直肠癌临床指征的患者的偏好，这些患者均接受了 CTC 和结肠镜检查。使用混合对数模型分析结果，并以 CTC 优于结肠镜检查的优势比（OR）表示。
随着 CTC 后需要进行第二次手术的可能性增加（偏好 CTC 而不是结肠镜检查的 OR = 0.013）、漏诊癌症或息肉的可能性增加（偏好 CTC 而不是结肠镜检查的 OR = 0.62）和 CTC 测试成本增加（偏好 CTC 而不是结肠镜检查的 OR = 0.65-0.80），结肠镜检查优于 CTC。如果可以进行最低限度的肠道准备，患者将更倾向于选择 CTC（OR = 1.7）。一些患者愿意为接受准备更不充分的 CTC 研究而换取结肠镜检查的诊断和治疗优势。偏好也因社会人口特征而异。
尽管 CTC 通常被认为是首选测试，但情况并非总是如此。对于结直肠癌的诊断测试，应该包括讨论替代测试的优势、劣势和不确定性，因为患者愿意并且能够在他们认为这些诊断测试的优势和劣势之间进行权衡。
