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Relationship between risk information on total colonoscopy and patient preferences for colorectal cancer screening options: analysis using the analytic hierarchy process.

ABSTRACT: BACKGROUND: Although the fecal occult blood test (FOBT) is the preferred program for colorectal cancer screening in Japan, many medical institutions have recently begun to provide total colonoscopy (TCS) as an initial screening program. However, there are a number of severe risks associated with TCS, such as colorectal bleeding and perforation. The justification for performing such a procedure on healthy patients remains unclear. We used the analytic hierarchy process (AHP) to investigate whether risk information on TCS affects patient preferences for colorectal cancer screening. METHODS: We performed a questionnaire survey using an AHP decision-making model, targeting 285 people aged 40-59 years. We randomly assigned the subjects into Groups A (n = 146) and B (n = 139). Both groups were provided with information on the effectiveness, cost and disadvantages of the two screening programs. Group A was provided with additional information regarding the risks of TCS. Individual priorities were calculated with pair-wise comparisons between the two alternatives in each selection criteria. The influence of the risk information was analyzed using a logistic regression analysis. RESULTS: The aggregated priorities in Group A for 'effectiveness', 'costs', and 'risks' were 0.603, 0.147, and 0.250, respectively, while those in Group B were 0.652, 0.149, and 0.199, respectively. A logistic regression analysis showed that the provision of risk information significantly reduced the subjects' priorities for TCS (p = 0.036). CONCLUSION: The lack of risk information was related to the differences in priorities assigned to effectiveness and risks of the two procedures. Patients must be well informed before making decisions concerning their preferred colorectal cancer screening procedure.

SUBMITTER: Katsumura Y

PROVIDER: S-EPMC2412845 | biostudies-other | 2008

REPOSITORIES: biostudies-other

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Relationship between risk information on total colonoscopy and patient preferences for colorectal cancer screening options: analysis using the analytic hierarchy process.

Katsumura Yuichi Y Yasunaga Hideo H Imamura Tomoaki T Ohe Kazuhiko K Oyama Hiroshi H

BMC health services research 20080521

<h4>Background</h4>Although the fecal occult blood test (FOBT) is the preferred program for colorectal cancer screening in Japan, many medical institutions have recently begun to provide total colonoscopy (TCS) as an initial screening program. However, there are a number of severe risks associated with TCS, such as colorectal bleeding and perforation. The justification for performing such a procedure on healthy patients remains unclear. We used the analytic hierarchy process (AHP) to investigate ...[more]

PMID: 18492286

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Project description:BackgroundIn 2021, the United States Preventive Services Task Force updated their recommendation, stating that individuals ages 45-49 should initiate screening for colorectal cancer. Since several screening strategies are recommended, making a shared decision involves including an individual's preferences. Few studies have included individuals under age 50. In this study, we use a multicriteria decision analysis technique called the Analytic Hierarchy Process to explore preferences for screening strategies and evaluate whether preferences vary by age.MethodsParticipants evaluated a hierarchy with 3 decision alternatives (colonoscopy, fecal immunochemical test, and computed tomography colonography), 3 criteria (test effectiveness, the screening plan, and features of the test) and 7 sub-criteria. We used the linear fit method to calculate consistency ratios and the eigenvector method for group preferences. We conducted sensitivity analysis to assess whether results are robust to change and tested differences in preferences by participant variables using chi-square and analysis of variance.ResultsOf the 579 individuals surveyed, 556 (96%) provided complete responses to the AHP portion of the survey. Of these, 247 participants gave responses consistent enough (CR < 0.18) to be included in the final analysis. Participants that were either white or have lower health literacy were more likely to be excluded due to inconsistency. Colonoscopy was the preferred strategy in those < 50 and fecal immunochemical test was preferred by those over age 50 (p = 0.002). These results were consistent when we restricted analysis to individuals ages 45-55 (p = 0.011). Participants rated test effectiveness as the most important criteria for making their decision (weight = 0.555). Sensitivity analysis showed our results were robust to shifts in criteria and sub-criteria weights.ConclusionsWe reveal potential differences in preferences for screening strategies by age that could influence the adoption of screening programs to include individuals under age 50. Researchers and practitioners should consider at-home interventions using the Analytic Hierarchy Process to assist with the formulation of preferences that are key to shared decision-making. The costs associated with different preferences for screening strategies should be explored further if limited resources must be allocated to screen individuals ages 45-49.

Project description:BACKGROUND:Clinical Practice Guidelines (CPGs) play an important role in clinical practice, and they require appropriate evaluation, especially in application. This study explores the application evaluation method of CPGs for Traditional Chinese Medicines (TCM). It uses the Analytic Hierarchy Process (AHP) and clinical cases to evaluate the consistency between CPGs of TCM and clinical practice. METHODS:To evaluate the consistency between CPGs of TCM and clinical cases, a 3-level AHP construction was built. Weightings were calculated by collecting questionnaires according to AHP theory. To test the evaluation system, a retrospective study was performed. The study evaluated the China Association of Chinese Medicine's Guidelines for Diagnosis and Treatment of Common Internal Diseases in Chinese Medicine Diseases of Modern Medicine (CPGs of DTCID) (ZYYXH/T50-135-2008). A total of 150 cases were involved. The evaluation system was used to assess the consistency between CPGs of DTCID and clinical cases of angina pectoris. RESULTS:The results showed that the overall consistency between CPGs of DTCID and the 150 cases was 42.32?±?6.94%, ranging from 35.21 to 63.37%. The overall consistency was not affected by age, gender, type of angina pectoris, condition of percutaneous coronary intervention (PCI), or angina classification as determined by the Canadian Cardiovascular Society. The consistencies of each index were as follows: Diagnosis of TCM, 100%; Diagnosis of Western medicine, 100%; Syndrome classification, 38.25?±?4.40%; Syndrome key point, 34.17?±?8.15%; TCM Decoction, 31.08?±?23.64%; TCM particular treatment, 7.92?±?19.13%; and Recuperation and prevention, 0. The most frequent syndromes were qi-deficiency, phlegm and blood stasis (n?=?124) (82.7%). The overall consistency of qi-deficiency, turbid phlegm and blood stasis was lower than the overall consistency of the group without that syndrome. The difference was statistically significant (P?<?0.05). 42 cases (28%) applied the TCM decoction recommended by CPGs of DTCID. Of these, Gualouxiebaibanxia decoction was applied in 34 cases. Wendan decoction, the most frequently used, was applied in 64 cases (42.7%). CONCLUSION:This study indicates that the AHP system can perform quantitative evaluation of consistency between TCM CPG and clinical practice. It also found the factors affecting the application of TCM CPGs and might indicate the need for revisions of CPGs.

Dataset Information

Relationship between risk information on total colonoscopy and patient preferences for colorectal cancer screening options: analysis using the analytic hierarchy process.

Publications

Relationship between risk information on total colonoscopy and patient preferences for colorectal cancer screening options: analysis using the analytic hierarchy process.

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