Brinkmann Melanie, Fricke Lara Marleen, Diedrich Leonie, Robra Bernt-Peter, Krauth Christian, Dreier Maren
Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Health Econ Rev. 2022 Sep 22;12(1):49. doi: 10.1186/s13561-022-00394-8.
The SIGMO study (Sigmoidoscopy as an evidence-based colorectal cancer screening test - a possible option?) examines screening eligible populations' preferences for colorectal cancer (CRC) screening in Germany using a discrete choice experiment (DCE). Attribute identification and selection are essential for the construction of choice tasks and should be evidence-based. As a part of the SIGMO study this systematic review provides an overview of attributes included in studies eliciting stated preferences for CRC screening tests and their relative importance for decision-making.
Systematic search (November 2021) for English-language studies published since January 2000 in PubMed, Embase, Web of Science, Biomedical Reference Collection: Corporate Edition, LIVIVO and PsycINFO. DCEs and conjoint analysis ranking or rating tasks on screening eligible populations' preferences for stool testing, sigmoidoscopy, and/or colonoscopy were included. Attributes were extracted and their relative importance was calculated and ranked. Risk of bias (RoB) of included studies was assessed using a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Study selection and RoB rating were carried out independently by two reviewers. Data were extracted by one reviewer and checked by another one.
A total of 23 publications on 22 studies were included. Overall RoB was rated as serious/critical for 21 studies and as moderate for 2 studies. Main reasons for high RoB were non-random sampling, low response rates, lack of non-responder analyses, and, to a lesser extent, weaknesses in the measurement instrument and data analysis. Extracted attributes (n = 120) referred to procedure-related characteristics (n = 42; 35%), structural characteristics of health care (n = 24; 20%), test characteristics (n = 23; 19%), harms (n = 16; 13%), benefits (n = 13; 11%), and level of evidence (n = 2; 2%). Most important attributes were reduction in CRC mortality (and incidence) (n = 7), test sensitivity (n = 7), out-of-pocket costs (n = 4), procedure (n = 3), and frequency (n = 2).
Health preference studies on CRC were found to have a high RoB. The composition of choice tasks revealed a lack of attributes on patient-important outcomes (like incidence reduction), while attributes not considered relevant for individual screening decisions (like sensitivity) were frequently used. Future studies eliciting stated preferences in cancer screening should apply the principles of informed decision-making in attribute identification and selection.
SIGMO研究（乙状结肠镜检查作为基于证据的结直肠癌筛查测试——一种可能的选择？）使用离散选择实验（DCE）研究了德国符合筛查条件人群对结直肠癌（CRC）筛查的偏好。属性识别和选择对于构建选择任务至关重要，并且应该基于证据。作为SIGMO研究的一部分，本系统评价概述了在引发对CRC筛查测试的明确偏好的研究中所包含的属性及其在决策中的相对重要性。
于2021年11月在PubMed、Embase、Web of Science、《生物医学参考数据库：企业版》、LIVIVO和PsycINFO中系统检索2000年1月以来发表的英文研究。纳入了关于符合筛查条件人群对粪便检测、乙状结肠镜检查和/或结肠镜检查偏好的DCE以及联合分析排序或评分任务。提取属性并计算其相对重要性并进行排名。使用改良的GRADE（推荐评估、制定和评价分级）方法评估纳入研究的偏倚风险（RoB）。由两名审阅者独立进行研究选择和RoB评级。数据由一名审阅者提取并由另一名审阅者检查。
共纳入了关于22项研究的23篇出版物。21项研究的总体RoB被评为严重/关键，2项研究为中等。高RoB的主要原因是非随机抽样、低应答率、缺乏无应答者分析，以及在较小程度上测量工具和数据分析方面的弱点。提取的属性（n = 120）涉及程序相关特征（n = 42；35%）、医疗保健的结构特征（n = 24；20%）、测试特征（n = 23；19%）、危害（n = 16；13%）、益处（n = 13；11%）和证据水平（n = 2；2%）。最重要的属性是CRC死亡率（和发病率）降低（n = 7）、测试敏感性（n = 7）、自付费用（n = 4）、程序（n = 3）和频率（n = 2）。
发现关于CRC的健康偏好研究具有较高的RoB。选择任务的构成显示缺乏关于对患者重要的结果（如发病率降低）的属性，而未被认为与个体筛查决策相关的属性（如敏感性）却经常被使用。未来在癌症筛查中引发明确偏好的研究应在属性识别和选择中应用知情决策原则。
