title: The effect of presenting information about invasive follow-up testing on individuals' noninvasive colorectal cancer screening participation decision: results from a discrete choice experiment.
abstract: OBJECTIVE
  Many national colorectal cancer screening campaigns have a similar structure. First, individuals are invited to take a noninvasive screening test, and, second, in the case of a positive screening test result, they are advised to undergo a more invasive follow-up test. The objective of this study was to investigate how much individuals' participation decision in noninvasive screening is affected by the presence or absence of detailed information about invasive follow-up testing and how this effect varies over screening tests.
  
  
  METHODS
  We used a labeled discrete choice experiment of three noninvasive colorectal cancer screening types with two versions that did or did not present respondents with detailed information about the possible invasive follow-up test (i.e., colonoscopy) and its procedure. We used data from 631 Dutch respondents aged 55 to 75 years. Each respondent received only one of the two versions (N = 310 for the invasive follow-up test information specification version, and N = 321 for the no-information specification version).
  
  
  RESULTS
  Mixed logit model results show that detailed information about the invasive follow-up test negatively affects screening participation decisions. This effect can be explained mainly by a decrease in choice shares for the most preferred screening test (a combined stool and blood sample test). Choice share simulations based on the discrete choice experiment indicated that presenting invasive follow-up test information decreases screening participation by 4.79%.
  
  
  CONCLUSIONS
  Detailed information about the invasive follow-up test has a negative effect on individuals' screening participation decisions in noninvasive colorectal cancer screening campaigns. This result poses new challenges for policymakers who aim not only to increase uptake but also to provide full disclosure to potential screening participants.
authors.affiliation: Institute of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands; CentERdata, Tilburg University, Tilburg, The Netherlands. Electronic address: t.m.benning@uvt.nl.
authors.forename: Tim M
authors.initials: TM
authors.lastname: Benning
authors.affiliation: Department of Business Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Benedict G C
authors.initials: BG
authors.lastname: Dellaert
authors.affiliation: Institute of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands; CAPRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
mesh_terms: D000368:Aged; D002755:Choice Behavior; D003113:Colonoscopy / Q000379:methods* / Q000523:psychology; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic / Q000379:methods*; D057240:Patient Preference; D011795:Surveys and Questionnaires
keywords: The Netherlands; colorectal cancer; conjoint analysis; preferences; public health