Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 3, 2023
Date Accepted: May 21, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Population Preferences for Blood-Based Colorectal Cancer Screening Tests: A Qualitative Study & Discrete Choice Experiment
ABSTRACT
Background:
Colorectal cancer (CRC) is a significant cause of mortality globally. Despite the availability of screening tests, their uptake remains suboptimal. Blood-based tests that look for signs of cancer-specific markers in the body are however increasingly available as an alternative for more invasive tests for cancer. Compared to existing tests, benefits of blood-based tests for CRC include not needing pre-test preparation, stool handling, and dietary or medication restrictions.
Objective:
This study aims to explore the population’s preferences for CRC screening tests, with a focus on blood-based tests, and investigate the factors influencing test uptake.
Methods:
The study employed a mixed-methods approach, combining semi-structured interviews and a discrete choice experiment (DCE) survey. Interviews were analysed using thematic analysis to identify salient attributes for CRC screening tests. These attributes informed the design of the DCE survey. The DCE data were analysed using mixed-logit (MXL) and mixed-mixed multinomial logit (MMML) models.
Results:
Qualitative findings from 30 participants revealed that participants preferred blood-based tests due to their perceived low risk, minimal pain, and ease of sample collection. However, concerns about the test's lower accuracy were also expressed. The DCE survey was completed by 1,189 participants. In the MXL model, participants demonstrated a stronger preference for blood-based tests over a 2-day stool-based test. The MMML model identified two classes, strong supporters for CRC screening and weak supporter for CRC screening. Weak supporters, but not strong supporters, had a higher preference for blood-based tests. Women, ethnic Chinese, and people aged 40 to 60 years were more likely to be weak supporters. Both models highlighted the high influence of cost and test sensitivity on participants' preferences. Transitioning from a 2-day stool-based test to a blood-based test, assuming a national screening program at a base price of SGD$5, was estimated to have the potential to increase the relative uptake by 5.9% [CI=3.6%, 8.2%].
Conclusions:
These findings contribute to our understanding of CRC screening preferences and provide insights into the factors driving test uptake. The study highlights the perceived advantages of blood-based tests and identifies areas of concern regarding their accuracy. Further research is needed to determine the actual increase in uptake rate when blood-based tests are made available.
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