Informed Decision Making Changes Test Preferences for Colorectal Cancer Screening in a Diverse Population

PURPOSE We wanted to better understand patient preferences and decision making about options for colorectal cancer screening. Consistency in patient preferences could improve patient-clinician communication about tests by simplifying and focusing discussions. METHODS In a cross-sectional sample of primary care patients, cognitive ranking tasks were used to estimate patient preferences for fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and double-contrast barium enema before and after consideration of 13 test attributes, such as accuracy and scientific evidence. Patients also ranked the 13 test attributes and attribute descriptions in terms of importance. Friedman's nonparametric test was used to measure overall discrimination among items, and the average Pearson correlation coefficient ((r) over bar) among participants was used to measure the degree of consistency in choices. RESULTS Participants (n = 168) averaged 62.1 years of age, and 64.3% were of minority racial ethnicity. For test-specific attributes, preferences were for high test accuracy ((r) over bar = 0.63, P <.001), amount of colon examined (<(r)over bar> = 0.64, P <.001), strong scientific evidence for efficacy (<(r)over bar> = 0.59, P <.001), minimum discomfort (<(r)over bar> = 0.50, P <.001), and low risk of complications (<(r)over bar> = 0.38, P <.001). When all 13 attributes were considered together, agreement dropped (<(r)over bar> = 0.13, P <.001), but attributes considered most important for decision making were test accuracy, scientific evidence for efficacy, amount of colon examined, and need for sedation. Test preferences showed moderate agreement (<(r)over bar> = 0.20, P <.001), and choices were fairly consistent before and after exposure to test-specific attributes (kappa = 0.17, P = .007). Initially the modal choice was fecal occult blood testing (59%); however, after exposure to test specific attributes, the modal choice was colonoscopy (54%). CONCLUSION Participants were clear about the attributes that they prefer, but no single test has those attributes. Preferences were varied across participants and were not predictable; clinicians should discuss the full range of recommended tests for colorectal cancer with all patients.