title: Modeling Individual Patient Preferences for Colorectal Cancer Screening Based on Their Tolerance for Complications Risk.
abstract: Recommendations for colorectal cancer screening encourage patients to choose among various screening methods based on individual preferences for benefits, risks, screening frequency, and discomfort. We devised a model to illustrate how individuals with varying tolerance for screening complications risk might decide on their preferred screening strategy.
  
  
  
  We developed a discrete-time Markov mathematical model that allowed hypothetical individuals to maximize expected lifetime utility by selecting screening method, start age, stop age, and frequency. Individuals could choose from stool-based testing every 1 to 3 years, flexible sigmoidoscopy every 1 to 20 years with annual stool-based testing, colonoscopy every 1 to 20 years, or no screening. We compared the life expectancy gained from the chosen strategy with the life expectancy available from a benchmark strategy of decennial colonoscopy.
  
  
  
  For an individual at average risk of colorectal cancer who was risk neutral with respect to screening complications (and therefore was willing to undergo screening if it would actuarially increase life expectancy), the model predicted that he or she would choose colonoscopy every 10 years, from age 53 to 73 years, consistent with national guidelines. For a similar individual who was moderately averse to screening complications risk (and therefore required a greater increase in life expectancy to accept potential risks of colonoscopy), the model predicted that he or she would prefer flexible sigmoidoscopy every 12 years with annual stool-based testing, with 93% of the life expectancy benefit of decennial colonoscopy. For an individual with higher risk aversion, the model predicted that he or she would prefer 2 lifetime flexible sigmoidoscopies, 20 years apart, with 70% of the life expectancy benefit of decennial colonoscopy.
  
  
  
  Mathematical models may formalize how individuals with different risk attitudes choose between various guideline-recommended colorectal cancer screening strategies.
authors.affiliation: Medicine Institute, Cleveland Clinic, Cleveland, OH (GBT).
authors.forename: Glen B
authors.initials: GB
authors.lastname: Taksler
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH (ATP).
authors.forename: Adam T
authors.initials: AT
authors.lastname: Perzynski
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH (MWK).
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000379:methods* / Q000523:psychology*; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D057240:Patient Preference / Q000523:psychology*; D018570:Risk Assessment
keywords: Markov models; cost-benefit analysis; decision analysis; gastroenterology; internal medicine; preventive medicine—screening; preventive services