title: Can Streamlined Multicriteria Decision Analysis Be Used to Implement Shared Decision Making for Colorectal Cancer Screening?
abstract: Current US colorectal cancer screening guidelines that call for shared decision making regarding the choice among several recommended screening options are difficult to implement. Multicriteria decision analysis (MCDA) is an established method well suited for supporting shared decision making. Our study goal was to determine whether a streamlined form of MCDA using rank-order-based judgments can accurately assess patients' colorectal cancer screening priorities.
  
  
  
  We converted priorities for 4 decision criteria and 3 subcriteria regarding colorectal cancer screening obtained from 484 average-risk patients using the analytic hierarchy process (AHP) in a prior study into rank-order-based priorities using rank order centroids. We compared the 2 sets of priorities using Spearman rank correlation and nonparametric Bland-Altman limits of agreement analysis. We assessed the differential impact of using the rank-order-based versus the AHP-based priorities on the results of a full MCDA comparing 3 currently recommended colorectal cancer screening strategies. Generalizability of the results was assessed using Monte Carlo simulation.
  
  
  
  Correlations between the 2 sets of priorities for the 7 criteria ranged from 0.55 to 0.92. The proportions of differences between rank-order-based and AHP-based priorities that were more than ±0.15 ranged from 1% to 16%. Differences in the full MCDA results were minimal, and the relative rankings of the 3 screening options were identical more than 88% of the time. The Monte Carlo simulation results were similar.
  
  
  
  Rank-order-based MCDA could be a simple, practical way to guide individual decisions and assess population decision priorities regarding colorectal cancer screening strategies. Additional research is warranted to further explore the use of these methods for promoting shared decision making.
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY (JGD)
authors.forename: James G
authors.initials: JG
authors.lastname: Dolan
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL (EB)
authors.forename: Emily
authors.initials: E
authors.lastname: Boohaker
authors.affiliation: University of Massachusetts, Worcester, MA (JA)
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine; Regenstrief Institute, Inc.; and Center of Excellence for Implementation of Evidence-based Medicine, Roudebush VA Medical Center, Indianapolis, IN (TFI).
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010358:Patient Participation / Q000379:methods*; D018570:Risk Assessment; D012959:Socioeconomic Factors
keywords: analytic hierarchy process; colorectal cancer screening; multicriteria decision analysis; shared decision making