Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
Health Expect. 2024 Aug;27(4):e14153. doi: 10.1111/hex.14153.
Risk stratification has been suggested as a strategy for improving cancer screening. Any changes to existing programmes must be acceptable to the public.
This study aimed to explore the preferences and considerations of individuals relating to the introduction of different risk-based strategies to determine eligibility for colorectal cancer (CRC) screening.
Participants completed a discrete choice experiment (DCE) within online interviews. Nine conjoint-analysis tasks were created, each with two potential CRC screening programmes. The attributes included personal risk of CRC, screening invitation strategy and impact. Participants chose between programmes while thinking aloud and sharing their thoughts. Transcripts were analysed using codebook thematic analysis.
Twenty participants based in England aged 40-79 years without previous cancer history or medical expertise.
When choosing between programmes, participants first and primarily looked to prioritise saving lives. The harms associated with screening were viewed as a surprise but also felt by most to be inevitable; the benefits frequently outweighed, therefore, harms were considered less important. Risk stratification using individual characteristics was considered a nuanced approach to healthcare, which tended to be preferred over the age-alone model. Detailed personal risk information could be taken more seriously than non-personalised information to motivate behaviour change. Although it had minimal impact on decision-making, not diverting resources for screening from elsewhere was valued. Individuals who chose not to provide health information were considered irresponsible, while it was important that those with no information to provide should not lose out.
Risk-stratified CRC screening is generally aligned with public preferences, with decisions between possible stratification strategies dominated by saving lives. Even if attributes including risk factors, risk stratification strategy and risk communication contributed less to the overall decision to select certain programmes, some levels more clearly fulfilled public values; therefore, all these factors should be taken into consideration when redesigning and communicating CRC screening programmes.
The primary data source for this study is interviews with 20 members of the public (current, past or future CRC screening invitees). Two public representatives contributed to planning this study, particularly the DCE.
风险分层已被提议作为改善癌症筛查的策略。任何对现有计划的改变都必须得到公众的认可。
本研究旨在探讨个人对引入不同基于风险的策略以确定结直肠癌（CRC）筛查资格的偏好和考虑因素。
参与者通过在线访谈完成了离散选择实验（DCE）。创建了九个联合分析任务，每个任务都有两个潜在的 CRC 筛查方案。属性包括个人 CRC 风险、筛查邀请策略和影响。参与者在选择方案时进行了思考，并分享了他们的想法。通过代码本主题分析对转录本进行了分析。
来自英格兰的 20 名年龄在 40-79 岁之间、无既往癌症史或医学专业知识的参与者。
当在方案之间进行选择时，参与者首先主要关注挽救生命。对筛查相关危害的看法是一种意外，但大多数人认为是不可避免的；因此，益处经常超过危害，因此危害被认为不那么重要。使用个体特征进行风险分层被认为是一种细致的医疗保健方法，倾向于比仅基于年龄的模式更受欢迎。详细的个人风险信息可能比非个性化信息更受重视，以激励行为改变。尽管它对决策的影响很小，但不将资源从其他地方转移用于筛查是有价值的。选择不提供健康信息的人被认为是不负责任的，而那些没有信息提供的人不应该失去机会。
风险分层 CRC 筛查通常与公众偏好一致，在可能的分层策略之间的决策主要由挽救生命主导。即使包括风险因素、风险分层策略和风险沟通在内的属性对选择特定方案的总体决策贡献较小，但某些方案更明显地满足了公众的价值观；因此，在重新设计和沟通 CRC 筛查计划时，应考虑所有这些因素。
本研究的主要数据来源是对 20 名公众（当前、过去或未来的 CRC 筛查邀请对象）的访谈。两名公众代表参与了本研究的计划，特别是 DCE。
