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Anyane‐Yeboa A, Aubertine M, Parker A, Sylvester K, Levell C, Bell E, Emmons KM, May FP. Use of a mixed-methods approach to develop a guidebook with messaging to encourage colorectal cancer screening among Black individuals 45 and older. Cancer Med 2023; 12:19047-19056. [PMID: 37602823 PMCID: PMC10557828 DOI: 10.1002/cam4.6461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States and disproportionately impacts Black individuals. Here, we describe the mixed-methods approach used to develop a tailored message guidebook to promote CRC screening among Black individuals in the setting of recently updated screening guidelines. METHODS This mixed-methods study included 10 in-depth qualitative interviews and 490 surveys in a nationally representative sample of unscreened Black individuals age ≥ 45. Messages were developed based on American Cancer Society (ACS) and National Colorectal Cancer Roundtable (NCCRT) research findings, tested among Black individuals using MaxDiff analytic methods, and reviewed by a multi-sector expert advisory committee of NCCRT members. RESULTS The most frequently reported screening barrier in all age groups was self-reported procrastination (40.0% in age 45-49, 42.8% for age 50-54, 34.2% for age ≥ 55). Reasons for procrastination varied by age and included financial concerns, COVID-19 concerns, and fear of the test and bowel preparation. Additional screening barriers included lack of symptoms, provider recommendation, and family history of CRC. Most individuals age 45-49 preferred to receive screening information from a healthcare provider (57.5%); however, only 20% reported that a provider had initiated a screening conversation. CONCLUSIONS We identified age-specific barriers to CRC screening and tailored messaging to motivate participation among unscreened Black people age ≥ 45. Findings informed the development of the NCCRT and ACS guidebook for organizations and institutions aiming to increase CRC screening participation in Black individuals.
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Affiliation(s)
| | | | | | - Kaitlin Sylvester
- American Cancer Society National Colorectal Cancer RoundtableKennesawGeorgiaUSA
| | - Caleb Levell
- American Cancer Society National Colorectal Cancer RoundtableKennesawGeorgiaUSA
| | - Emily Bell
- American Cancer Society National Colorectal Cancer RoundtableKennesawGeorgiaUSA
| | - Karen M. Emmons
- Harvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Folasade P. May
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Kaiser Permanente Center for Health Equity and Jonsson Comprehensive Cancer Center, University of California Los AngelesLos AngelesCaliforniaUSA
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Methodology to derive preference for health screening programmes using discrete choice experiments: a scoping review. BMC Health Serv Res 2022; 22:1079. [PMID: 36002895 PMCID: PMC9400308 DOI: 10.1186/s12913-022-08464-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/08/2022] [Indexed: 12/18/2022] Open
Abstract
Background While involving users in healthcare decision-making has become increasingly common and important, there is a lack of knowledge about how to best design community-based health screening programs. Reviews of methods that incorporate discrete choice experiments (DCEs) are scarce, particularly for non-cancer illnesses like cardiovascular disease, diabetes and liver disease. We provide an overview of currently available applications and methods available by using DCEs in health screening programs, for chronic conditions. Methods A scoping review was undertaken, where four electronic databases were searched for key terms to identify eligible DCE studies related to community health screening. We included studies that met a pre-determined criteria, including being published between 2011 and 2021, in English and reported findings on human participants. Data were systematically extracted, tabulated, and summarised in a narrative review. Results A total of 27 studies that used a DCE to elicit preferences for cancer (n = 26) and cardiovascular disease screening (n = 1) programmes were included in the final analysis. All studies were assessed for quality, against a list of 13 criteria, with the median score being 9/13 (range 5–12). Across the 27 studies, the majority (80%) had the same overall scores. Two-thirds of included studies reported a sample size calculation, approximately half (13/27) administered the survey completely online and over 75% used the general public as the participating population. Conclusion Our review has led to highlighting several areas of current practice that can be improved, particularly greater use of sample size calculations, increased use of qualitative methods, better explanation of the chosen experimental design including how choice sets are generated, and methods for analysis. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08464-7.
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Conjoint Analysis: A Research Method to Study Patients’ Preferences and Personalize Care. J Pers Med 2022; 12:jpm12020274. [PMID: 35207762 PMCID: PMC8879380 DOI: 10.3390/jpm12020274] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023] Open
Abstract
This article aims to describe the conjoint analysis (CA) method and its application in healthcare settings, and to provide researchers with a brief guide to conduct a conjoint study. CA is a method for eliciting patients’ preferences that offers choices similar to those in the real world and allows researchers to quantify these preferences. To identify literature related to conjoint analysis, a comprehensive search of PubMed (MEDLINE), EMBASE, Web of Science, and Google Scholar was conducted without language or date restrictions. To identify the trend of publications and citations in conjoint analysis, an online search of all databases indexed in the Web of Science Core Collection was conducted on the 8th of December 2021 without time restriction. Searching key terms covered a wide range of synonyms related to conjoint analysis. The search field was limited to the title, and no language or date limitations were applied. The number of published documents related to CA was nearly 900 during the year 2021 and the total number of citations for CA documents was approximately 20,000 citations, which certainly shows that the popularity of CA is increasing, especially in the healthcare sciences services discipline, which is in the top five fields publishing CA documents. However, there are some limitations regarding the appropriate sample size, quality assessment tool, and external validity of CA.
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Clark SD, Reuland DS, Brenner AT, Pignone MP. What is the effect of a decision aid on knowledge, values and preferences for lung cancer screening? An online pre-post study. BMJ Open 2021; 11:e045160. [PMID: 34244253 PMCID: PMC8273450 DOI: 10.1136/bmjopen-2020-045160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine if a decision aid improves knowledge of lung cancer screening benefits and harms and which benefits and harms are most valued. DESIGN Pre-post study. SETTING Online. PARTICIPANTS 219 current or former (quit within the previous 15 years) smokers ages 55-80 with at least 30 pack-years of smoking. INTERVENTION Lung cancer screening video decision aid. MAIN MEASURES Screening knowledge tested by 10 pre-post questions and value of benefits and harms (reducing chance of death from lung cancer, risk of being diagnosed, false positives, biopsies, complications of biopsies and out-of-pocket costs) assessed through rating (1-5 scale) and ranking (top three ranked). RESULTS Mean age was 64.7±6.1, 42.5% were male, 75.4% white, 48.4% married, 28.9% with less than a college degree and 67.6% with income <US$50 000. Knowledge improved postdecision aid (pre 2.8±1.8 vs post 5.8±2.3, diff +3.0, 95% CI 2.7 to 3.3; p<0.001). For values, reducing the chance of death from lung cancer was rated and ranked highest overall (rating 4.3±1.0; 59.4% ranked first). Among harms, avoiding complications (3.7±1.3) and out-of-pocket costs (3.7±1.2) rated highest. Thirty-four per cent ranked one of four harms highest: avoiding costs 13.2%, false positives 7.3%, biopsies 7.3%, complications 5.9%. Screening intent was balanced (1-4 scale; 1-not likely 21.0%, 4-very likely 26.9%). Those 'not likely' to screen had greater improvement in pre-post knowledge scores and more frequently ranked a harm first than those 'very likely' to screen (pre-post diff:+3.5 vs +2.6, diff +0.9; 95% CI 0.1 to 1.8; p=0.023; one of four harms ranked first: 28.4% vs 11.3%, p<0.001). CONCLUSIONS Our decision aid increased lung cancer screening knowledge among a diverse sample of screen-eligible respondents. Although a majority valued 'reducing the chance of death from lung cancer' highest, a substantial proportion identified harms as most important. Knowledge improvement and ranking harms highest were associated with lower intention to screen.
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Affiliation(s)
- Stephen D Clark
- Division of General Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Daniel S Reuland
- Division of General Medicine & Clinical Epidemiology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Alison T Brenner
- Division of General Medicine & Clinical Epidemiology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael P Pignone
- Department of Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
- Cancer Institutes, Dell Medical School, LIVESTRONG, Austin, Texas, USA
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Schapira MM, Rodriguez KL, Chhatre S, Fraenkel L, Bastian LA, Kravetz JD, Asan O, Akers S, Vachani A, Prigge JM, Meline J, Ibarra JV, Corn B, Kaminstein D. When Is a Harm a Harm? Discordance between Patient and Medical Experts' Evaluation of Lung Cancer Screening Attributes. Med Decis Making 2021; 41:317-328. [PMID: 33554740 DOI: 10.1177/0272989x20987221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms. OBJECTIVE To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies. DESIGN Cross-sectional study with semistructured interviews and a card-sort activity. PARTICIPANTS Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female. APPROACH Semistructured interviews with thematic coding. MAIN MEASURES The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization. KEY RESULTS In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty. CONCLUSIONS Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.
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Affiliation(s)
- Marilyn M Schapira
- The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Keri L Rodriguez
- CHERP, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sumedha Chhatre
- The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA.,The Department of Psychiatry, the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Liana Fraenkel
- VA Connecticut Healthcare System, West Haven, CT, USA.,Yale University School of Medicine, New Haven, CT, USA
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, CT, USA.,Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey D Kravetz
- VA Connecticut Healthcare System, West Haven, CT, USA.,Yale University School of Medicine, New Haven, CT, USA
| | - Onur Asan
- The Stevens Institute of Technology, School of Systems and Enterprises, Hoboken, NJ, USA
| | - Scott Akers
- Department of Radiology, The Michael J. Crescenz VA Medical Center and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anil Vachani
- The Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jason M Prigge
- The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA
| | - Jessica Meline
- The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA
| | | | - Barbara Corn
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Dana Kaminstein
- The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA.,Organizational Dynamics, Liberal and Professional Studies, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA, USA
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Studts JL, Thurer RJ, Brinker K, Lillie SE, Byrne MM. Brief Education and a Conjoint Valuation Survey May Reduce Decisional Conflict Regarding Lung Cancer Screening. MDM Policy Pract 2020; 5:2381468319891452. [PMID: 31976372 PMCID: PMC6956606 DOI: 10.1177/2381468319891452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 10/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background. Recent data and policy decisions have led to the availability of lung cancer screening (LCS) for individuals who are at increased risk of developing lung cancer. In establishing implementation policies, the US Preventive Services Task Force recommended and the Centers for Medicare and Medicaid Services required that individuals who meet eligibility criteria for LCS receive a patient counseling and shared decision-making consultation prior to LCS. Methods. This study evaluated the potential of a values clarification/preference elicitation exercise and brief educational intervention to reduce decisional conflict regarding LCS. Participants (N = 210) completing a larger online survey responded to a measure of decisional conflict prior to and following administration of a conjoint survey and brief educational narrative about LCS. The conjoint survey included 22 choice sets (two of which were holdout cards), incorporating 5 attributes with 17 levels. Results. Results pertaining to changes in decisional conflict showed that participants reported statistically significantly and clinically meaningful reductions in decisional conflict following administration of the brief educational narrative and conjoint survey across the total score (Δ = 29.30; d = 1.09) and all four decisional conflict subscales: Uncertainty (Δ = 27.75; d = 0.73), Informed (Δ = 35.32; d = 1.11), Values Clarity (Δ = 31.82; d = 0.85), and Support (Δ = 18.78; d = 0.66). Discussion. While the study design precludes differentiating the effects of the brief educational narrative and the conjoint survey, data suggest that these tools offer a reasonable approach to clarifying personal beliefs and perspectives regarding LCS participation. Given the complicated nature of LCS decisions and recent policies advocating informed and shared decision-making approaches, conjoint surveys should be evaluated as one of the tools that could help individuals make choices about LCS participation.
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Affiliation(s)
- Jamie L. Studts
- Department of Behavioral Science, University of Kentucky Markey Cancer Center, Lexington, Kentucky
- Cancer Prevention and Control Program, University of Kentucky Markey Cancer Center, Lexington, Kentucky
- Behavioral and Community-Based Research Shared Resource Facility, University of Kentucky Markey Cancer Center, Lexington, Kentucky
| | - Richard J. Thurer
- Department of Surgery, Division of Cardiothoracic Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Kory Brinker
- Behavioral and Community-Based Research Shared Resource Facility, University of Kentucky Markey Cancer Center, Lexington, Kentucky
| | - Sarah E. Lillie
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Margaret M. Byrne
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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Byrne MM, Thurer RJ, Studts JL. Individual decision making about lung cancer screening: A conjoint analysis of perspectives among a high-risk national sample. Cancer Med 2019; 8:5779-5786. [PMID: 31385463 PMCID: PMC6745859 DOI: 10.1002/cam4.2445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/21/2019] [Accepted: 07/14/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Lung cancer screening (LCS) is effective in reducing lung cancer mortality, but there is limited information available regarding preferences among high-risk individuals concerning LCS. In this study, we use a conjoint valuation analysis (CVA) to better understand which LCS attributes most affect LCS preferences. MATERIALS AND METHODS We implemented a web-based nationally representative survey that included a full-profile CVA exercise. Participants were over the age of 45, had at least a 20 pack-year smoking history, and no history of lung cancer. The CVA instrument included five LCS attributes, and additional survey items collected demographic and psychosocial information. RESULTS Participants (n = 210) had a mean age of 61 (SD 8.5) years, approximately half were female (51.9%), and were racially/ethnically diverse. Average relative importance of the LCS program attributes was (from high to low): out of pocket costs (27.3 ± 17.7); provider recommendation (24.8 ± 13.4); mortality reduction (17.2 ± 8.9); false-positive rate (15.8 ± 10.4); and ease of access (14.8 ± 7.3). There was large variation among individuals, but few significant associations of propensity to screen with individual demographic characteristics. Average screening propensity across individuals (1-9 scale) was 3.63 ± 1.6, and average rates of individual scenarios ranged from 2.60 ± 2.00 to 5.57 ± 2.13, indicating low inclination for screening. CONCLUSIONS We found that overall propensity for screening is low in a high-risk population, and that out of pocket costs were of greater importance to potential screeners than mortality reduction or false-positive rates. Thus, individuals considering or eligible for LCS need additional education and support regarding the LCS landscape in order to achieve informed decision making.
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Affiliation(s)
- Margaret M Byrne
- Department of Health Outcomes and Behavior, H Lee Moffitt Cancer Center, Tampa, Florida
| | - Richard J Thurer
- Department of Surgery and Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jamie L Studts
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky.,Cancer Prevention and Control Program, University of Kentucky Markey Cancer Center, Lexington, Kentucky
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