Hummel J Marjan, Steuten Lotte G M, Groothuis-Oudshoorn C J M, Mulder Nick, Ijzerman Maarten J
Department of Health Technology and Services Research, MIRA, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands,
Appl Health Econ Health Policy. 2013 Oct;11(5):499-507. doi: 10.1007/s40258-013-0051-z.
Despite the expected health benefits of colorectal cancer screening programs, participation rates remain low in countries that have implemented such a screening program. The perceived benefits and risks of the colorectal cancer screening technique are likely to influence the decision to attend the screening program. Besides the diagnostic accuracy and the risks of the screening technique, which can affect the health of the participants, additional factors, such as the burden of the test, may impact the individuals' decisions to participate. To maximise the participation rate of a screening program for a new colorectal cancer program in the Netherlands, it is important to know the preferences of the screening population for alternative screening techniques.
The aim of this study was to explore the impact of preferences for particular attributes of the screening tests on the intention to attend a colorectal cancer screening program.
We used a web-based questionnaire to elicit the preferences of the target population for a selection of colon-screening techniques. The target population consisted of Dutch men and women aged 55-75 years. The analytic hierarchy process (AHP), a technique for multi-criteria analysis, was used to estimate the colorectal cancer screening preferences. Respondents weighted the relevance of five criteria, i.e. the attributes of the screening techniques: sensitivity, specificity, safety, inconvenience, and frequency of the test. With regard to these criteria, preferences were estimated between four alternative screening techniques, namely, immunochemical fecal occult blood test (iFOBT), colonoscopy, sigmoidoscopy, and computerized tomographic (CT) colonography. A five-point ordinal scale was used to estimate the respondents' intention to attend the screening. We conducted a correlation analysis on the preferences for the screening techniques and the intention to attend.
We included 167 respondents who were consistent in their judgments of the relevance of the criteria and their preferences for the screening techniques. The most preferred screening method for the national screening program was CT colonography. Sensitivity (weight = 0.26) and safety (weight = 0.26) were the strongest determinants of the overall preferences for the screening techniques. However, the screening test with the highest intention to attend was iFOBT. Inconvenience (correlation [r] = 0.69), safety (r = 0.58), and the frequency of the test (r = 0.58) were most strongly related to intention to attend.
The multi-criteria decision analysis revealed the attributes of the screening techniques that are most important so as to increase intention to participate in a screening program. Even though the respondents may recognize the high importance of diagnostic effectiveness in the long term, their short-term decision to attend the screening tests may be less driven by this consideration. Our analysis suggests that inconvenience, safety, and frequency of the test are the strongest technique-related determinants of the respondents' intention to participate in colorectal screening programs.
尽管结直肠癌筛查项目预期会带来健康益处，但在已实施此类筛查项目的国家，参与率仍然很低。结直肠癌筛查技术所感知到的益处和风险可能会影响参加筛查项目的决定。除了可能影响参与者健康的筛查技术的诊断准确性和风险外，其他因素，如检测负担，也可能影响个人参与的决定。为了使荷兰一项新的结直肠癌筛查项目的参与率最大化，了解筛查人群对替代筛查技术的偏好很重要。
本研究的目的是探讨对筛查测试特定属性的偏好对参加结直肠癌筛查项目意愿的影响。
我们使用基于网络的问卷来获取目标人群对一系列结肠筛查技术的偏好。目标人群包括55 - 75岁的荷兰男性和女性。层次分析法（AHP），一种多标准分析技术，用于估计结直肠癌筛查偏好。受访者对五个标准的相关性进行加权，即筛查技术的属性：敏感性、特异性、安全性、不便程度和检测频率。关于这些标准，在四种替代筛查技术之间估计偏好，即免疫化学粪便潜血试验（iFOBT）、结肠镜检查、乙状结肠镜检查和计算机断层扫描（CT）结肠造影。使用五点有序量表来估计受访者参加筛查的意愿。我们对筛查技术的偏好和参加意愿进行了相关性分析。
我们纳入了167名受访者，他们对标准的相关性和筛查技术的偏好判断一致。国家筛查项目最受欢迎的筛查方法是CT结肠造影。敏感性（权重 = 0.26）和安全性（权重 = 0.26）是筛查技术总体偏好的最强决定因素。然而，参加意愿最高的筛查测试是iFOBT。不便程度（相关性[r] = 0.69）、安全性（r = 0.58）和检测频率（r = 0.58）与参加意愿的相关性最强。
多标准决策分析揭示了对提高参与筛查项目意愿最重要的筛查技术属性。尽管受访者可能认识到长期诊断有效性的高度重要性，但他们参加筛查测试的短期决定可能较少受此考虑因素驱动。我们的分析表明，不便程度、安全性和检测频率是受访者参与结直肠癌筛查项目意愿的最强技术相关决定因素。
