1 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada 2 Alberta Health Services Cancer Care, Calgary, Alberta, Canada 3 Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Patient. 2010 Jun 1;3(2):79-89. doi: 10.2165/11532250-000000000-00000.
There is a growing interest in the application of preferences to inform healthcare planning and delivery. Clinical practice guidelines are encouraging incorporation of preferences in patient management choices in recognition that often no single approach is best.The objective of this focused review is to provide an overview of the current state of preference measurement for colorectal cancer screening (CRCS) and highlight the implications for health policy, CRCS program implementation, and further research.MEDLINE and EMBASE electronic databases were searched (1990-May 2009) for English-language literature examining patient preferences for CRCS, using conjoint analysis methods. We systematically extracted information on the study population, whether the choice sets were framed around specific CRCS tests or the overall program, the attributes and levels included, and, where available, the ordering of importance of the attributes and key study findings.Qualitative data synthesis of key differences and commonalities in the approaches and findings are presented. Six conjoint analysis studies of CRCS were identified. While 66-88% of respondents in the general population indicated they would choose CRCS, this is greater than observed rates of uptake (40-50%). All studies were administered in a sample of the general population at average risk of CRC, except one that included a sample of physicians. The studies varied in the attributes and levels they included. However, accuracy, whether expressed in the context of a CRCS test or program, was consistently identified as a statistically significant and important attribute. Other attributes included in the conjoint analysis studies included level of discomfort during the test, preparation for the test, the testing process, frequency of testing, frequency of complications, the process of follow up, and cost.Our results suggested that (i) a majority of people would choose to be screened for CRC, although actual CRCS participation rates suggest otherwise; (ii) patients have distinct preferences for CRCS tests that can be linked to CRC test attributes; and consequently, (iii) there is no single CRCS test that is preferred by everyone. In addition, although the specific approach, attributes, and levels in the studies varied, they consistently found that multiple factors are important from the patient's perspective and that preferences vary amongst subgroups. Consequently, careful consideration should be given to the design and implementation of a CRCS program based on a broader range of factors than the traditional outcomes such as mortality and incidence reduction. Attention should now be focused on how to use this information to inform health policy and develop CRCS programs that will increase screening uptake and adherence in the context of the health system in which the program will be provided. We propose a two-step process to designing and implementing a CRCS program based on evidence and preferences that informs patient choice.
人们越来越关注将偏好应用于医疗保健规划和提供中。临床实践指南鼓励在患者管理决策中纳入偏好，因为通常没有一种方法是最好的。本重点综述的目的是概述结直肠癌筛查（CRCS）偏好测量的现状，并强调对健康政策、CRCS 计划实施和进一步研究的影响。使用联合分析方法，检索 MEDLINE 和 EMBASE 电子数据库（1990 年 5 月至 2009 年），以获取关于患者对 CRCS 偏好的英文文献。我们系统地提取了有关研究人群的信息，无论是围绕特定的 CRCS 测试还是整个计划构建选择集，包括的属性和水平，以及在可用的情况下，属性和主要研究结果的重要性排序。呈现了方法和研究结果中关键差异和共性的定性数据综合。确定了 6 项关于 CRCS 的联合分析研究。虽然一般人群中有 66-88％的受访者表示他们会选择 CRCS，但这高于观察到的采用率（40-50％）。除了一项包括医生样本的研究外，所有研究均在 CRC 平均风险的一般人群样本中进行。研究在纳入的属性和水平上有所不同。然而，准确性（无论是在 CRCS 测试还是计划的背景下表达）都被一致确定为具有统计学意义的重要属性。联合分析研究中包括的其他属性包括测试期间的不适程度、测试准备、测试过程、测试频率、并发症频率、随访过程和成本。我们的结果表明：（i）尽管实际的 CRCS 参与率表明并非如此，但大多数人会选择筛查 CRC；（ii）患者对 CRCS 测试有明显的偏好，可以与 CRC 测试属性相关联；因此，（iii）并非每个人都喜欢单一的 CRCS 测试。此外，尽管研究中的具体方法、属性和水平有所不同，但它们一致发现，从患者的角度来看，许多因素都很重要，并且偏好因亚组而异。因此，应根据死亡率和发病率降低等传统结果以外的更广泛因素，慎重考虑 CRCS 计划的设计和实施。现在应关注如何利用这些信息为健康政策提供信息，并制定将增加筛查参与度和依从性的 CRCS 计划，以适应提供计划的卫生系统。我们提出了一个基于证据和偏好的两步过程来设计和实施一个 CRCS 计划，为患者选择提供信息。
