title: Using willingness-to-pay to establish patient preferences for cancer testing in primary care.
abstract: Shared decision making is a stated aim of several healthcare systems. In the area of cancer, patients' views have informed policy on screening and treatment but there is little information about their views on diagnostic testing in relation to symptom severity.
  
  
  
  We used the technique of willingness-to-pay to determine public preferences around diagnostic testing for colorectal, lung, and pancreatic cancer in primary care in the UK. Participants were approached in general practice waiting rooms and asked to complete a two-stage electronic survey that described symptoms of cancer, the likelihood that the symptoms indicate cancer, and information about the appropriate diagnostic test. Part 1 asked for a binary response (yes/no) as to whether they would choose to have a test if it were offered. Part 2 elicited willingness-to-pay values of the tests using a payment scale followed by a bidding exercise, with the aim that these values would provide a strength of preference not detectable using the binary approach.
  
  
  
  A large majority of participants chose to be tested for all cancers, with only colonoscopy (colorectal cancer) demonstrating a risk gradient. In the willingness-to-pay exercise participants placed a lower value on an X-ray (lung cancer) than the tests for colorectal or pancreatic cancer and X-ray was the only test where risk was clearly related to the willingness-to-pay value.
  
  
  
  Willingness-to-pay values did not enhance the binary responses in the way intended; participants appeared to be motivated differently when responding to the two parts of the questionnaire. More work is needed to understand how participants perceive risk in this context and how they respond to questions about willingness-to-pay. Qualitative methods could provide useful insights.
authors: School of Social and Community Medicine, University of Bristol, Bristol, UK. s.p.hollinghurst@bristol.ac.uk.
authors: Sandra
authors: 0000-0003-0782-3117
authors: S
authors: Hollinghurst
authors: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Jonathan
authors: J
authors: Banks
authors: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Lin
authors: L
authors: Bigwood
authors: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors: Fiona M
authors: FM
authors: Walter
authors: University of Exeter Medical School, Exeter, UK.
authors: Willie
authors: W
authors: Hamilton
authors: School of Clinical Sciences, University of Bristol, Bristol, UK.
authors: Tim J
authors: TJ
authors: Peters
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000592:standards*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000191:economics; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000191:economics; D057240:Patient Preference / Q000191:economics*; D011320:Primary Health Care / Q000191:economics / Q000592:standards*
keywords: Cancer; Diagnostic tests; Primary health care; Willingness-to-pay