Department of Community & Preventive Medicine, University of Rochester Medical Center, Rochester, New York (JGD)
University of Alabama at Birmingham, Birmingham, Alabama (EB)
Med Decis Making. 2013 Jan;33(1):59-70. doi: 10.1177/0272989X12453502. Epub 2012 Aug 15.
US colorectal cancer screening guidelines for people at average risk for colorectal cancer endorse multiple screening options and recommend that screening decisions reflect individual patient preferences.
The authors used the analytic hierarchy process (AHP) to ascertain decision priorities of people at average risk for colorectal cancer attending primary care practices in Rochester, New York; Birmingham, Alabama; and Indianapolis, Indiana. The analysis included 4 decision criteria, 3 subcriteria, and 10 options.
Four hundred eighty-four people completed the study; 66% were female, 49% were African American, 9% had low literacy skills, and 27% had low numeracy skills. Overall, preventing cancer was given the highest priority (mean priority 55%), followed by avoiding screening test side effects (mean priority 17%), minimizing false-positive test results (mean priority 15%), and the combined priority of screening frequency, test preparation, and the test procedure(s) (mean priority 14%). Hierarchical cluster analysis revealed 6 distinct priority groupings containing multiple instances of decision priorities that differed from the average value by a factor of 4 or more. More than 90% of the study participants fully understood the concepts involved, 79% met AHP analysis quality standards, and 88% were willing to use similar methods to help make important health care decisions.
These results highlight the need to facilitate incorporation of patient preferences into colorectal cancer screening decisions. The large number of study participants able and willing to perform the complex AHP analysis used for this study suggests that the AHP is a useful tool for identifying the patient-specific priorities needed to ensure that screening decisions appropriately reflect individual patient preferences.
美国结直肠癌筛查指南针对结直肠癌平均风险人群，认可多种筛查方案，并建议筛查决策应反映个体患者的偏好。
作者使用层次分析法（AHP）确定在纽约罗切斯特、阿拉巴马州伯明翰和印第安纳州印第安纳波利斯的初级保健诊所就诊的结直肠癌平均风险人群的决策优先级。分析包括 4 个决策标准、3 个子标准和 10 个选项。
484 人完成了这项研究；66%为女性，49%为非裔美国人，9%的人阅读能力较低，27%的人计算能力较低。总的来说，预防癌症的优先级最高（平均优先级为 55%），其次是避免筛查试验的副作用（平均优先级为 17%）、最小化假阳性试验结果（平均优先级为 15%），以及筛查频率、测试准备和测试程序的综合优先级（平均优先级为 14%）。层次聚类分析显示 6 个不同的优先级分组，其中包含多个决策优先级，与平均值相差 4 倍以上。超过 90%的研究参与者完全理解所涉及的概念，79%符合 AHP 分析质量标准，88%愿意使用类似的方法来帮助做出重要的医疗保健决策。
这些结果强调了需要促进将患者偏好纳入结直肠癌筛查决策。研究中有大量的参与者能够且愿意执行用于本研究的复杂 AHP 分析，这表明 AHP 是一种有用的工具，可以确定确保筛查决策适当反映个体患者偏好所需的患者特定优先级。
