Preferences for colorectal cancer screening among racially/ethnically diverse primary care patients.
BACKGROUND
Incorporating patients' preferences into colorectal cancer (CRC) screening recommendations has been identified as a potential mechanism for increasing adherence. This study used conjoint analysis to describe variation in CRC screening preferences among racially/ethnically diverse primary care patients.


METHODS
We recruited patients ages 50-80 of a large practice-based research network stratified by white, African American, or Hispanic race/ethnicity to complete a preference assessment instrument. Participants were asked to rate 8 hypothetical CRC screening test scenarios comprised of different combinations of 5 attributes and 6 scenarios designed to depict guideline-recommended CRC screening tests (eg, fecal occult blood test, flexible sigmoidoscopy, colonoscopy, and double contrast barium enema) including new technology (eg, virtual colonoscopy, fecal immunochemical test). Responses were used to calculate the overall importance of test attributes, the relative importance of attribute levels, and to identify factors associated with preferences.


RESULTS
Two hundred twelve primary care patients were recruited to the study (74 white, 60 African American, 78 Hispanic). Of the guideline-recommended tests, 37% preferred COL, 31% FOBT, 15% BE, and 9% SIG. Ratings of new technology tests were significantly (P < 0.05) higher than ratings of guideline-recommended tests. The order of the importance of attributes was: what the test involved (37%), accuracy (19%), frequency (17%), discomfort (15%), and preparation (13%). Part-worth utilities for 1 attribute showed that collecting a stool sample was most preferable and endoscopy without sedation least preferable. Multivariate regression found that race/ethnicity and specific test attributes were independently associated (P < 0.05) with test preferences.


CONCLUSIONS
Primary care patients have distinct preferences for CRC screening tests that can be linked to test attributes. Racial/ethnic variations in test preferences persist when controlling for attributes. Tailoring screening recommendations to patients' preferences may increase screening adherence.
Hawley
Sarah T
ST
Department of Internal Medicine, Division of General Medicine and Ann Arbor VA Healthcare System, University of Michigan, Ann Arbor, Michigan 48109, USA. sarahawl@umich.edu
Volk
Robert J
RJ
Krishnamurthy
Partha
P
Jibaja-Weiss
Maria
M
Vernon
Sally W
SW
Kneuper
Suzanne
S
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology* / Q000523:psychology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010353:Patient Education as Topic; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data