Liu Ruyue, Lu Youhua, Li Yifan, Wei Wenjian, Sun Chen, Zhang Qianqian, Wang Xin, Wang Jialin, Zhang Nan
School of Public Health, Weifang Medical University, Weifang, China.
Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Front Oncol. 2022 Jul 27;12:917622. doi: 10.3389/fonc.2022.917622. eCollection 2022.
The low uptake rate of upper gastrointestinal cancer (UGC) screening substantially reduces the benefits of endoscopic screening. This study aimed to obtain residents' UGC screening preferences to optimize screening strategies and increase the participation rate.
A discrete choice experiment (DCE) was conducted to assess UGC screening preferences of 1,000 rural residents aged 40 to 70 years from three countries (Linqu, Feicheng, and Dongchangfu) of Shandong province in China. The DCE questionnaire was developed from five attributes: out-of-pocket costs, screening interval, regular follow-up for precancerous lesions, mortality reduction, and screening technique. The data from the DCE were analyzed within the framework of random utility theory using a mixed logit model.
In total, 926 of 959 residents who responded were analyzed. The mean (SD) age was 57.32 (7.22) years. The five attributes all significantly affected residents' preferences, and the painless endoscopy had the most important impact (=2.927, P<0.01), followed by screening interval of every year ( = 1.184, P<0.01). Policy analyses indicated that switching the screening technique to painless endoscopy would increase the participation rate up to 89.84% (95%CI: 87.04%-92.63%). Residents aged 40-49, with a history of cancer, with a family income of more than ¥30,000 were more likely to participate in a screening.
UGC screening implementation should consider residents' preferences to maximize the screening participation rate. Resources permitting, we can carry out the optimal screening program with shorter screening intervals, lower out-of-pocket costs, less pain, follow-up, and higher UGC mortality reduction.
上消化道癌（UGC）筛查的低参与率显著降低了内镜筛查的益处。本研究旨在了解居民对上消化道癌筛查的偏好，以优化筛查策略并提高参与率。
采用离散选择实验（DCE）评估来自中国山东省三个县（临朐、肥城和东昌府）的1000名40至70岁农村居民对上消化道癌筛查的偏好。DCE问卷由五个属性构成：自付费用、筛查间隔、癌前病变定期随访、死亡率降低以及筛查技术。使用混合逻辑模型在随机效用理论框架内分析DCE数据。
总共对959名有回应的居民中的926名进行了分析。平均（标准差）年龄为57.32（7.22）岁。这五个属性均显著影响居民的偏好，无痛内镜检查的影响最为重要（=2.927，P<0.01），其次是每年的筛查间隔（=1.184，P<0.01）。政策分析表明，将筛查技术改为无痛内镜检查可使参与率提高至89.84%（95%置信区间：87.04%-92.63%）。40至49岁、有癌症病史、家庭收入超过3万元的居民更有可能参与筛查。
上消化道癌筛查的实施应考虑居民的偏好，以最大限度提高筛查参与率。在资源允许的情况下，我们可以开展最佳筛查方案，缩短筛查间隔，降低自付费用，减少痛苦、随访，并提高上消化道癌死亡率降低幅度。
