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Kato T, Sasaki K, Nagata K, Hirayama M, Endo S, Horita S. Acceptance and Preference of Computed Tomographic Colonography and Colonoscopy: Results of a Nationwide Multicenter Comparative Questionnaire Survey in Japan. J Anus Rectum Colon 2024; 8:84-95. [PMID: 38689783 PMCID: PMC11056531 DOI: 10.23922/jarc.2023-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/10/2023] [Indexed: 05/02/2024] Open
Abstract
Objectives To investigate patient acceptance and preference for computed tomographic colonography (CTC) over colonoscopy. Methods Participants were recruited from a nationwide multicenter trial in Japan to assess the accuracy of CTC detection. They were scheduled to undergo colonoscopy after CTC with common bowel preparation on the same day. Some were administered sedative drugs during colonoscopy, depending on the referring clinician and participant's preferences. The participants were requested to complete a questionnaire to evaluate the acceptability of bowel preparation, examinations, and preference for future examinations. Results Of the 1,257 enrolled participants, 1,180 (mean age: 60.6 years; women: 43.3%) completed the questionnaire. Sedative drugs were not administered in 687 participants (unsedated colonoscopy group) and were administered intravenously during colonoscopy in 493 participants (sedated colonoscopy group). Before propensity score matching, the mean participants' age, percentages of asymptomatic participants, insufflation of gas during colonoscopy, and number of participants with a history of abdominal/pelvic operation significantly differed between the groups. After propensity score matching, 912 participants from each group were included in the analysis. In the unsedated colonoscopy group, CTC was answered as significantly easier than colonoscopy (p<0.001). Conversely, CTC was significantly more difficult than colonoscopy in the sedated colonoscopy group (p<0.001). In the unsedated colonoscopy group, 48% preferred CTC and 22% preferred colonoscopy for future examinations, whereas in the sedated colonoscopy group, 26% preferred CTC and 38% preferred colonoscopy (p<0.001). Conclusions CTC has superior participant acceptability compared with unsedated colonoscopy. However, our study did not observe the advantages of CTC acceptance over sedative colonoscopy.
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Affiliation(s)
- Takashi Kato
- Department of Gastroenterology, Tomakomai City Hospital, Tomakomai, Japan
| | - Kiyotaka Sasaki
- Department of Internal Medicine, Hokkaido Gastroenterological Hospital, Sapporo, Japan
| | - Koichi Nagata
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | | | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Shoichi Horita
- Department of Internal Medicine, Hokkaido Gastroenterological Hospital, Sapporo, Japan
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Mondragón Márquez LI, Domínguez Bueso DL, González Ruiz LM, Liu JJ. Associations between sociodemographic factors and breast, cervical, and colorectal cancer screening in the United States. Cancer Causes Control 2023; 34:1073-1084. [PMID: 37486400 DOI: 10.1007/s10552-023-01758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Cancer is the second leading cause of death globally and in the U.S., but screening can reduce cancer-related deaths. We analyzed data from a nationwide survey to compare how sociodemographic factors were associated with never or not timely screening for multiple types of cancer, and the use of different colorectal cancer screening procedures. METHODS We analyzed data from the 2019 U.S. National Health Interview Survey. To understand breast, cervical, and colorectal cancer screening participation among those recommended to screen, we respectively analyzed 8,110 women 45 to 74 years of age, 9,583 women 21 to 65 years of age, and 13,497 individuals 50 to 75 years of age at survey. Weighted Poisson regression was used to estimate the unadjusted and confounding-adjusted prevalence ratio and 95% confidence intervals. RESULTS In our analysis populations, 6.9% never had a mammogram, 14.6% never screened for cervical cancer, and 26.8% never screened for colorectal cancer; the prevalence respectively increased to 24.7%, 23.8%, and 32.3% for not timely screening according to national guidelines. The prevalence of never screening was 81.9% for non-invasive colorectal cancer tests, compared with 32.5% for colonoscopy or sigmoidoscopy. Individuals with lower education level, with no health insurance, or in poverty had higher prevalence of never screening for all three cancers. There was low sociodemographic disparity for the use of non-invasive colorectal cancer screening tests. CONCLUSION Socioeconomically disadvantaged individuals have higher prevalence of never or not timely screening. The utilization of non-invasive colorectal cancer screening procedures remains low across sociodemographic groups.
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Affiliation(s)
| | | | - Liza M González Ruiz
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jason J Liu
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Public Health, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan.
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Baird TA, Wright DR, Britto MT, Lipstein EA, Trout AT, Hayatghaibi SE. Patient Preferences in Diagnostic Imaging: A Scoping Review. THE PATIENT 2023; 16:579-591. [PMID: 37667148 DOI: 10.1007/s40271-023-00646-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND As new diagnostic imaging technologies are adopted, decisions surrounding diagnostic imaging become increasingly complex. As such, understanding patient preferences in imaging decision making is imperative. OBJECTIVES We aimed to review quantitative patient preference studies in imaging-related decision making, including characteristics of the literature and the quality of the evidence. METHODS The Pubmed, Embase, EconLit, and CINAHL databases were searched to identify studies involving diagnostic imaging and quantitative patient preference measures from January 2000 to June 2022. Study characteristics that were extracted included the preference elicitation method, disease focus, and sample size. We employed the PREFS (Purpose, Respondents, Explanation, Findings, Significance) checklist as our quality assessment tool. RESULTS A total of 54 articles were included. The following methods were used to elicit preferences: conjoint analysis/discrete choice experiment methods (n = 27), contingent valuation (n = 16), time trade-off (n = 4), best-worst scaling (n = 3), multicriteria decision analysis (n = 3), and a standard gamble approach (n = 1). Half of the studies were published after 2016 (52%, 28/54). The most common scenario (n = 39) for eliciting patient preferences was cancer screening. Computed tomography, the most frequently studied imaging modality, was included in 20 studies, and sample sizes ranged from 30 to 3469 participants (mean 552). The mean PREFS score was 3.5 (standard deviation 0.8) for the included studies. CONCLUSIONS This review highlights that a variety of quantitative preference methods are being used, as diagnostic imaging technologies continue to evolve. While the number of preference studies in diagnostic imaging has increased with time, most examine preventative care/screening, leaving a gap in knowledge regarding imaging for disease characterization and management.
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Affiliation(s)
- Trey A Baird
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Davene R Wright
- Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Maria T Britto
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Ellen A Lipstein
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Andrew T Trout
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shireen E Hayatghaibi
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Hall R, Medina-Lara A, Hamilton W, Spencer A. Women's priorities towards ovarian cancer testing: a best-worst scaling study. BMJ Open 2022; 12:e061625. [PMID: 36581964 PMCID: PMC9438192 DOI: 10.1136/bmjopen-2022-061625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate the importance of key characteristics relating to diagnostic testing for ovarian cancer and to understand how previous test experience influences priorities. DESIGN Case 1 best-worst scaling embedded in an online survey. SETTING Primary care diagnostic testing in England and Wales. PARTICIPANTS 150 women with ovaries over 40 years old living in England and Wales. METHODS We used best-worst scaling, a preference-based survey method, to elicit the relative importance of 25 characteristics relating to ovarian cancer testing following a systematic review. Responses were modelled using conditional logit regression. Subgroup analysis investigated variations based on testing history. MAIN OUTCOME MEASURES Relative importance scores. RESULTS 'Chance of dying from ovarian cancer' (0.380, 95% CI 0.26 to 0.49) was the most important factor to respondents, closely followed by 'test sensitivity' (0.308, 95% CI 0.21 to 0.40). In contrast, 'time away from usual activities' (-0.244, 95% CI -0.33 to -0.15) and 'gender of healthcare provider' (-0.243, 95% CI -0.35 to -0.14) were least important to respondents overall. Women who had previously undergone testing placed higher importance on certain characteristics including 'openness of healthcare providers' and 'chance of diagnosing another condition' at the expense of reduced emphasis on characteristics such as 'pain and discomfort' and 'time away from usual activities'. CONCLUSIONS The results clearly demonstrated items at the extreme, which were most and least important to women considering ovarian cancer testing. Differences in priorities by testing history demonstrate an experience effect, whereby preferences adapt over time based on evidence and experience. Acknowledging these differences helps to identify underlying barriers and facilitators for women with no test experience as well as shortcomings of current service based on women with experience.
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Affiliation(s)
- Rebekah Hall
- Health Economics Group, University of Exeter Medical School, Exeter, UK
| | | | - Willie Hamilton
- Primary Care Diagnostics, University of Exeter Medical School, Exeter, UK
| | - Anne Spencer
- Health Economics Group, University of Exeter Medical School, Exeter, UK
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Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population? GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3040018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.
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Raghunandan R, Howard K, Marra CA, Tordoff J, Smith A. Identifying New Zealand Public Preferences for Pharmacist Prescribers in Primary Care: A Discrete Choice Experiment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:77-92. [PMID: 34109570 DOI: 10.1007/s40271-021-00529-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Given increasing patient populations, general practitioner workforce constraints and the growing demand for health services in New Zealand (NZ), the development and provision of pharmacist prescribing services could be used to improve people's access to medicines. A discrete choice experiment (DCE) was utilised to determine NZ public preferences for pharmacist prescribing services in primary care in NZ. METHODS A D-efficient DCE design generated 20 choice questions in four blocks of five questions with three labelled alternatives per choice question. The online DCE used a NZ general public online research panel administered by an external organisation (SurveyEngine). The DCE included six attributes with two attributes each with two levels (location of consultation and consultation type), three levels (type of service and operating hours) and four levels (waiting time and cost). RESULTS Nine hundred and twenty-four respondents completed the survey with 4620 observations available for analyses. Respondents preferred pharmacist prescribing services with the following characteristics: optimisation of medicines and changes to only current medicine service types (relative to repeat prescribing); lower consultation costs, shorter waiting times, longer operating hours and consultation by appointment (relative to walk-in and wait clinic). CONCLUSIONS Prescribing policy could incorporate these public preferences to help develop accessible and effective primary care prescribing services utilising the skills of pharmacist prescribers to improve and reduce inequities in access to medicines in NZ. These results suggest the NZ public see pharmacists as part of the primary care prescribing team and are willing to utilise them if these services are implemented.
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Affiliation(s)
- Rakhee Raghunandan
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand.
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Carlo A Marra
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand
| | - June Tordoff
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand
| | - Alesha Smith
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand
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Phisalprapa P, Ngorsuraches S, Wanishayakorn T, Kositamongkol C, Supakankunti S, Chaiyakunapruk N. Estimating the preferences and willingness-to-pay for colorectal cancer screening: an opportunity to incorporate the perspective of population at risk into policy development in Thailand. J Med Econ 2021; 24:226-233. [PMID: 33467947 DOI: 10.1080/13696998.2021.1877145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS Colorectal cancer (CRC) is one of the public health burdens that can be lowered by early detection. This study aims to examine the preferences and willingness-to-pay of a population at risk for CRC screening in Thailand. Understanding the preferences for these individuals at risk would help Thailand, as an example of LMICs, to design effective population-based CRC screening programs. MATERIALS AND METHODS A discrete choice experiment (DCE) was conducted among screening-naïve adults aged 50-75 years, who were at risk of CRC, in the out-patient department of a tertiary care hospital in Thailand. A DCE questionnaire was developed from six CRC screening attributes. Each questionnaire was composed of six choice sets and each contained two alternatives described by the different levels of attributes and an opt-out alternative. Participants were asked to choose one alternative from each choice set. A multinomial logit model was developed to determine the relative preference of each attribute. The willingness-to-pays for all attributes and screening modalities and the estimated preferred choices of the annual fecal immunochemical test (FIT), 10-yearly colonoscopy, 5-yearly double-contrast barium enema (DCBE), 5-yearly computed tomographic colonography (CTC), 5-yearly flexible sigmoidoscopy (FS), and no screening was calculated and compared. RESULTS Four hundred participants were included. All attributes, except pain and less bowel preparation, were statistically associated with the participants' preference (p < .05). They preferred screenings with a high-risk reduction of CRC-related mortality, no complication, 5-year interval, and lower cost. The estimated preferred choices of FIT, colonoscopy, DCBE, CTC, and FS were 38.2%, 11.4%, 14.6%, 9.2%, and 11.4%, respectively. The willingness-to-pays for each screening modality was US$251, US$189, US$183, US$154, and US$142 (8,107, 6,105, 5,911, 4,974, and 4,587 THB) per episode, respectively. CONCLUSIONS The risk reduction of CRC-related mortality, complication, screening interval, and cost influenced the CRC screening preferences of Thai adults. FIT was the most preferred. Policymakers can develop a successful CRC screening campaign using these findings, incorporating the perspective of the population at risk in policy formulation to accomplish their goals.
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Affiliation(s)
- Pochamana Phisalprapa
- Center of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Tanatape Wanishayakorn
- Faculty of Pharmaceutical Sciences (Pharmacy Administration), Prince of Songkhla University, Songkhla, Thailand
| | - Chayanis Kositamongkol
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Siripen Supakankunti
- Center of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
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8
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Mott DJ, Hampson G, Llewelyn MJ, Mestre-Ferrandiz J, Hopkins MM. A Multinational European Study of Patient Preferences for Novel Diagnostics to Manage Antimicrobial Resistance. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:69-79. [PMID: 31541361 PMCID: PMC6978300 DOI: 10.1007/s40258-019-00516-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Novel diagnostics are needed to manage antimicrobial resistance (AMR). Patient preferences are important in determining whether diagnostic tests are successful in practice, but there are few data describing the test attributes which matter most to patients. We elicited patients' preferences for attributes of diagnostic tests that could be used to reduce unnecessary antibiotic use in primary care across seven European countries. METHODS We used an online stated preference survey, including a discrete choice experiment (DCE). The DCE explored how patients make trade-offs between three key attributes of diagnostic tests: the speed that results were available, confidence in the test results, and how convenient it is to take the test. Individuals were eligible to complete the survey if they had taken antibiotics within the last 2 years and were resident in Germany, Italy, Spain, France, Greece, the Netherlands or the United Kingdom (UK). RESULTS In total, 988 respondents completed the survey. The DCE responses illustrated that speed was the least important attribute in most countries. Responses from Germany and the Netherlands indicated that confidence was most important in these countries. Responses from the UK, France, Spain and Italy showed convenience as the most important attribute in these countries. Two attributes, confidence and convenience, were jointly favoured by respondents in Greece. CONCLUSION Patients in different European countries do not have the same preferences for the attributes of diagnostic tests to manage AMR in primary care. Failure to account for such differences during test development could reduce test uptake, result in continued overuse of antibiotics, and hamper marketisation.
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Affiliation(s)
- David J Mott
- Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London, UK.
| | - Grace Hampson
- Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London, UK
| | | | - Jorge Mestre-Ferrandiz
- Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London, UK
- Independent Economics Consultant, Madrid, Spain
| | - Michael M Hopkins
- Science Policy Research Unit, University of Sussex Business School, Jubilee Building, Falmer, Brighton, UK
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Kato T, Nagata K, Yamamichi J, Tanaka S, Honda T, Shimizu N, Utano K, Hirayama M, Matsumoto H, Horita S. Preference and Experience of Colonic Examination for Participants Presenting to Hospitals with a Positive Fecal Immunochemical Test Result. Patient Prefer Adherence 2020; 14:2017-2025. [PMID: 33122895 PMCID: PMC7588835 DOI: 10.2147/ppa.s267354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/10/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Patients who test positive on the fecal immunochemical test (FIT) for colorectal cancer (CRC) are referred for colonoscopy for further diagnostic evaluation. Colonoscopy is not a perfect method and may be a challenge for some FIT-positive patients. Computed tomographic colonography (CTC) is an alternative method that is less invasive and allows examination of the whole colon. The study objective was to evaluate the preference of FIT-positive patients for either colonoscopy or CTC for CRC examination. PATIENTS AND METHODS Individuals older than 40 years with a positive FIT test at eight Japanese hospitals between December 2012 and July 2015 were invited to participate. Participants were given detailed information regarding colonoscopy and CTC before deciding on either examination. They completed questionnaires before the procedure regarding their preference and after the procedure regarding their experience. RESULTS The pre- and post-questionnaires of 846 and 834 participants, respectively, were analyzed. Participants preferred colonoscopy over CTC (colonoscopy, 72%; CTC, 28%). The possibility of obtaining biopsy samples and removing colorectal polyps during the procedure was the main reason for colonoscopy selection. Patients selected CTC to reduce discomfort but reported that CTC bowel preparation was more burdensome than colonoscopy bowel preparation. The overall experience of the examination did not differ between the groups. CONCLUSION Colonoscopy is the standard examination for FIT-positive patients. However, when given a choice, almost one-third of participants chose CTC because they thought it would be a more "comfortable" examination. Clinicians should therefore be aware of patients' potential preference for noninvasive colorectal examinations.
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Affiliation(s)
- Takashi Kato
- Department of Internal Medicine, Hokkaido Gastroenterological Hospital, Sapporo, Japan
- Correspondence: Takashi KatoDepartment of Internal Medicine, Hokkaido Gastroenterological Hospital, Sapporo, Hokkaido065-0041, JapanTel +8111-784-1811Fax +8111-784-1838 Email
| | - Koichi Nagata
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Junta Yamamichi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Soichi Tanaka
- Department of Coloproctology, Matsuaikai Matsuda Hospital, Hamamatsu, Japan
| | - Tetsuro Honda
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Norihito Shimizu
- Department of Radiology, Medical Corporation Matsuoka Clinic, Nara, Japan
| | - Kenichi Utano
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima, Japan
| | | | - Hiroshi Matsumoto
- Department of Gastroenterology, Kawasaki Medical University School of Medicine, Kurashiki, Japan
| | - Shoichi Horita
- Department of Internal Medicine, Hokkaido Gastroenterological Hospital, Sapporo, Japan
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Ramezani Doroh V, Delavari A, Yaseri M, Emamgholipour Sefiddashti S, Akbarisari A. Preferences of Iranian average risk population for colorectal cancer screening tests. Int J Health Care Qual Assur 2019; 32:677-687. [PMID: 31111783 DOI: 10.1108/ijhcqa-08-2017-0151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to explore the preferences of the average risk Iranian population for colorectal cancer (CRC) screening tests. DESIGN/METHODOLOGY/APPROACH A standard stated-preferences method with discrete choice models was used to identify the preferences. Data about socio-demographic status, health status and preferences for CRC screening tests were collected by a structured questionnaire that was completed by 500 people aged 50-75 years. Mixed logit model was used to analyze the preferences. FINDINGS The regression model showed that the test process, pain, place, frequency, preparation, sensitivity, complication risk, mortality rate and cost were the final attributes; that had a statistically significant correlation with the preferences of the people in choosing CRC screening tests. The socio-demographic and health status of participants had no significant correlation with the individuals' preferences. PRACTICAL IMPLICATIONS This study provides insight into how different characteristics of a CRC screening test might influence the preferences of individuals about that test. ORIGINALITY/VALUE This was the first study of this type in Iran to elicit the preferences of the average risk population for CRC screening tests using a discrete choice model.
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Affiliation(s)
- Vajiheh Ramezani Doroh
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
| | - Alireza Delavari
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
| | - Sara Emamgholipour Sefiddashti
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
| | - Ali Akbarisari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences , Tehran, The Islamic Republic of Iran
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Railey AF, Lankester F, Lembo T, Reeve R, Shirima G, Marsh TL. Enhancing livestock vaccination decision-making through rapid diagnostic testing. WORLD DEVELOPMENT PERSPECTIVES 2019; 16:100144. [PMID: 32201751 PMCID: PMC7067263 DOI: 10.1016/j.wdp.2019.100144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
•Compared to vaccination, the collective approach to diagnostic testing presents a low-fixed cost.•Existing household livestock-health behaviors increase the likelihood for uptake of preventative health practices.•Initial evidence to support household investments in livestock preventative health over therapeutic treatments.
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Affiliation(s)
- Ashley F. Railey
- Paul G. Allen School for Global Animal Health, Washington State University, USA
- Corresponding author.
| | - Felix Lankester
- Paul G. Allen School for Global Animal Health, Washington State University, USA
| | - Tiziana Lembo
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - Richard Reeve
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - Gabriel Shirima
- Paul G. Allen School for Global Animal Health, Washington State University, USA
- Nelson Mandela African Institution of Science and Technology, Tanzania
| | - Thomas L. Marsh
- Paul G. Allen School for Global Animal Health, Washington State University, USA
- School of Economic Sciences, Washington State University, USA
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Weinberg DS, Mitnick J, Keenan E, Li T, Ross EA. Post-operative colorectal cancer surveillance: preference for optical colonoscopy over computerized tomographic colonography. Cancer Causes Control 2019; 30:1269-1273. [PMID: 31531798 PMCID: PMC7534185 DOI: 10.1007/s10552-019-01231-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/08/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Post-operative surveillance strategies for colorectal cancer (CRC) include periodic optical colonoscopy (OC) and abdominal-pelvic CT scan. Adherence with these recommendations is limited. For CRC screening, CT colonography (CTC) identifies larger adenomas and cancers nearly as well as OC. Most screening studies demonstrate that patients prefer CTC. However, CTC has never been compared to OC in the post-operative surveillance setting. METHODS We hypothesized that CTC might represent an attractive substitute for the standard OC/CT scan combination. Here, 223 patients underwent CTC followed by same day OC 1 year after curative CRC resection. RESULTS Of the 144/223 (64.6%) participants with a preference, 65.9% (95/144) preferred OC. This preference was more pronounced in women and in patients with polyps detected. No additional patient level factors significantly altered this primary result. CONCLUSIONS In contrast to CRC screening, this first study in CRC post-operative surveillance patients demonstrates a preference for OC. Assuming patient preference is an important determinant, introduction of CTC as a method to increase patient adherence with CRC surveillance is unlikely to be effective. TRIAL REGISTRATION Clinical Trials.gov registration number: NCT02143115.
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Affiliation(s)
- David S Weinberg
- Fox Chase Cancer Center, Philadelphia, PA, USA.
- Department of Medicine, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | | | | | - Tianyu Li
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Eric A Ross
- Fox Chase Cancer Center, Philadelphia, PA, USA
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Trapero-Bertran M, Rodríguez-Martín B, López-Bastida J. What attributes should be included in a discrete choice experiment related to health technologies? A systematic literature review. PLoS One 2019; 14:e0219905. [PMID: 31318926 PMCID: PMC6639002 DOI: 10.1371/journal.pone.0219905] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 07/04/2019] [Indexed: 01/12/2023] Open
Abstract
Discrete choice experiments (DCEs) are a way to assess priority-setting in health care provision. This approach allows for the evaluation of individuals’ preferences as a means of adding criteria to traditional quality-adjusted life year analysis. The aim of this systematic literature review was to identify attributes for designing a DCE in order to then develop and validate a framework that supports decision-making on health technologies. Our systematic literature review replicated the methods and search terms used by de Bekker-Grob et al. 2012 and Clark et al. 2014. The Medline database was searched for articles dated between 2008 and 2015. The search was limited to studies in English that reflected general preferences and were choice-based, published as full-text articles and related to health technologies. This study included 72 papers, 52% of which focused on DCEs on drug treatments. The average number of attributes used in all included DCE studies was 5.74 (SD 1.98). The most frequently used attributes in these DCEs were improvements in health (78%), side effects (57%) and cost of treatment (53%). Other, less frequently used attributes included waiting time for treatment or duration of treatment (25%), severity of disease (7%) and value for money (4%). The attributes identified might inform future DCE surveys designed to study societal preferences regarding health technologies in order to better inform decisions in health technology assessment.
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Affiliation(s)
- Marta Trapero-Bertran
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Beatriz Rodríguez-Martín
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
- Faculty of Health Sciences, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Julio López-Bastida
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
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Preferences for Colorectal Cancer Screening Tests: Differences Between Insured and Uninsured Beneficiaries of Iranian Health Transformation Plan. HEALTH SCOPE 2018. [DOI: 10.5812/jhealthscope.63213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pedersen JM, Mortensen EL, Christensen DS, Rozing M, Brunsgaard H, Meincke RH, Petersen GL, Lund R. Prenatal and early postnatal stress and later life inflammation. Psychoneuroendocrinology 2018; 88:158-166. [PMID: 29291495 DOI: 10.1016/j.psyneuen.2017.12.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Evidence suggests that maternal psychological and social stress during the prenatal period and in childhood represent an important condition that may adversely impact the anatomy and physiology of the developing child with implications for a number of health-related conditions and disorders. In a large prospective study, we aim to address if social stressors in the prenatal and early postnatal periods, as individual exposures as well as their accumulation, are associated with a range of inflammatory markers in late middle-aged offspring. METHODS The study sample includes Danish men and women born between 1959 and 1961 (n = 1206) who were members of the Copenhagen Perinatal Cohort and participated in the Copenhagen Aging and Midlife Biobank in 2009-2011 (age 49-52). Information on social stressors was collected through an interview with the mothers at the first antenatal visit and postnatal stressor data was collected at year one follow-up. A series of ordinary least square regression models were performed with the stress measures as the exposures and C-reactive protein (CRP), Interleukin-6 (IL-6), Interleukin-10 (IL-10), and Tumor necrosis factor α (TNF-α) separately as the outcomes. RESULTS The individual prenatal maternal stressors (being unmarried and having an unwanted pregnancy) and the prenatal index were associated with higher levels of CRP and IL-6 among offspring but not with IL-10 or TNF-α. Low social status, but not living away from parents or having an unmarried mother in the first year of life, was associated with higher levels of CRP and IL-6. The accumulation of social stressors in the early postnatal period was associated with higher levels of CRP and IL-6 but not IL-10 and TNF-α. The accumulation of stressors in the prenatal and postnatal periods combined was associated with higher levels of CRP and IL-6, but not with IL-10 or TNF-α. CONCLUSIONS The findings suggest that exposure to the accumulation of prenatal and early life stressors, is associated with higher levels of CRP and IL-6 in later life. This may indicate that the effects of early stressors on later inflammation operate through pathways with clear links to cardiovascular disease.
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Affiliation(s)
- Jolene Masters Pedersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.
| | - Erik Lykke Mortensen
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark; Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dinne Skjærlund Christensen
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark; Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Rozing
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Helle Brunsgaard
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - Rikke Hodal Meincke
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Lindved Petersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Abstract
OBJECTIVES Differences in the process of using liver imaging technologies might be important to patients. This study aimed to investigate preferences for scanning modalities used in diagnosing focal liver lesions. METHODS A discrete choice experiment was administered to 504 adults aged 25 ≥years. Respondents made repeated choices between two hypothetical scans, described according to waiting time for scan and results, procedure type, the chance of minor side-effects, and whether further scanning procedures were likely to be required. Choice data were analyzed using mixed-logit models with respondent characteristics used to explain preference heterogeneity. RESULTS Respondents preferred shorter waiting times, the procedure to be undertaken with a handheld scanner on a couch instead of within a body scanner, no side-effects, and no follow–up scans (p≤.01). The average respondent was willing to wait an additional 2 weeks for the scan if it resulted in avoiding side-effects, 1.5 weeks to avoid further procedures or to be told the results immediately, and 1 week to have the scan performed on a couch with a handheld scanner. However, substantial heterogeneity was observed in the strength of preference for desirable imaging characteristics. CONCLUSIONS An average individual belonging to a general population sub–group most likely to require imaging to characterize focal liver lesions in the United Kingdom would prefer contrast–enhanced ultrasound over magnetic resonance imaging or computed tomography. Insights into the patient perspective around differential characteristics of imaging modalities have the potential to be used to guide recommendations around the use of these technologie
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Franco MR, Howard K, Sherrington C, Rose J, Ferreira PH, Ferreira ML. Smallest worthwhile effect of exercise programs to prevent falls among older people: estimates from benefit-harm trade-off and discrete choice methods. Age Ageing 2016; 45:806-812. [PMID: 27496928 DOI: 10.1093/ageing/afw110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/05/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND the smallest worthwhile effect (SWE) of an intervention is the smallest treatment effect that justifies the costs, risks and inconveniences associated with that health intervention. OBJECTIVE to estimate the SWE of exercise programs designed to prevent falls among older people and to compare estimates derived by two methodological approaches. STUDY DESIGN AND SETTING discrete choice experiment (n = 220) and benefit-harm trade-off (subsample n = 66) methods were used. PARTICIPANTS community-dwelling older people who reported a past fall or a mobility limitation answered online or face-to-face questionnaires. RESULTS a substantial proportion of participants (82% in the discrete choice experiment and 50% in the benefit-harm trade-off study) did not consider that participation in the proposed exercise programs would be worthwhile, even if it reduced their risk of falling to 0%. Among remaining participants, the average SWE of participation in an exercise program was an absolute reduction in the risk of falling of 35% (standard deviation [SD] = 13) in the discrete choice experiment and 16% (SD = 11) in the benefit-harm trade-off study. CONCLUSIONS many participants did not consider the hypothetical falls' risk reduction of the proposed exercise programs to be worth the associated costs and inconveniences. Greater community awareness of the fall prevention effects of exercise for older people is required.
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Affiliation(s)
- M R Franco
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - K Howard
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - C Sherrington
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - J Rose
- School of Commerce, University of South Australia, South Australia, Australia
| | - P H Ferreira
- Faculty of Health Science, The University of Sydney, Sydney, New South Wales, Australia
| | - M L Ferreira
- The George Institute for Global Health & Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Mansfield C, Tangka FKL, Ekwueme DU, Smith JL, Guy GP, Li C, Hauber AB. Stated Preference for Cancer Screening: A Systematic Review of the Literature, 1990-2013. Prev Chronic Dis 2016; 13:E27. [PMID: 26916898 PMCID: PMC4768876 DOI: 10.5888/pcd13.150433] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction Stated-preference methods provide a systematic approach to quantitatively assess the relative preferences for features of cancer screening tests. We reviewed stated-preference studies for breast, cervical, and colorectal cancer screening to identify the types of attributes included, the use of questions to assess uptake, and whether gaps exist in these areas. The goal of our review is to inform research on the design and promotion of public health programs to increase cancer screening. Methods Using the PubMed and EconLit databases, we identified studies published in English from January 1990 through July 2013 that measured preferences for breast, cervical, and colorectal cancer screening test attributes using conjoint analysis or a discrete-choice experiment. We extracted data on study characteristics and results. We categorized studies by whether attributes evaluated included screening test, health care delivery characteristics, or both. Results Twenty-two studies met the search criteria. Colorectal cancer was the most commonly studied cancer of the 3. Fifteen studies examined only screening test attributes (efficacy, process, test characteristics, and cost). Two studies included only health care delivery attributes (information provided, staff characteristics, waiting time, and distance to facility). Five studies examined both screening test and health care delivery attributes. Overall, cancer screening test attributes had a significant effect on a patient’s selection of a cancer screening test, and health care delivery attributes had mixed effects on choice. Conclusion A growing number of studies examine preferences for cancer screening tests. These studies consistently find that screening test attributes, such as efficacy, process, and cost, are significant determinants of choice. Fewer studies have examined the effect of health care delivery attributes on choice, and the results from these studies are mixed. There is a need for additional studies on the barriers to cancer screening uptake, including health care delivery attributes, and the effect of education materials on preferences.
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Affiliation(s)
- Carol Mansfield
- RTI Health Solutions, RTI International, Research Triangle Park, North Carolina
| | - Florence K L Tangka
- Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS F-76, Atlanta, GA 30341.
| | | | | | - Gery P Guy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chunyu Li
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - A Brett Hauber
- RTI Health Solutions, RTI International, Research Triangle Park, North Carolina
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Eliciting older people's preferences for exercise programs: a best-worst scaling choice experiment. J Physiother 2015; 61:34-41. [PMID: 25499647 DOI: 10.1016/j.jphys.2014.11.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/02/2014] [Accepted: 11/05/2014] [Indexed: 11/22/2022] Open
Abstract
QUESTION What relative value do older people with a previous fall or mobility-related disability attach to different attributes of exercise? DESIGN Prospective, best-worst scaling study. PARTICIPANTS Two hundred and twenty community-dwelling people, aged 60 years or older, who presented with a previous fall or mobility-related disability. METHODS Online or face-to-face questionnaire. OUTCOME MEASURES Utility values for different exercise attributes and levels. The utility levels were calculated by asking participants to select the attribute that they considered to be the best (ie, they were most likely to want to participate in programs with this attribute) and worst (ie, least likely to want to participate). The attributes included were: exercise type; time spent on exercise per day; frequency; transport type; travel time; out-of-pocket costs; reduction in the chance of falling; and improvement in the ability to undertake tasks inside and outside of home. RESULTS The attributes of exercise programs with the highest utility values were: home-based exercise and no need to use transport, followed by an improvement of 60% in the ability to do daily tasks at home, no costs, and decreasing the chances of falling to 0%. The attributes with the lowest utility were travel time of 30 minutes or more and out-of-pocket costs of AUD50 per session. CONCLUSION The type of exercise, travel time and costs are more highly valued by older people than the health benefits. These findings suggest that physical activity engagement strategies need to go beyond education about health benefits and focus on improving accessibility to exercise programs. Exercise that can be undertaken at or close to home without any cost is most likely to be taken up by older people with past falls and/or mobility-related disability.
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Clark MD, Determann D, Petrou S, Moro D, de Bekker-Grob EW. Discrete choice experiments in health economics: a review of the literature. PHARMACOECONOMICS 2014; 32:883-902. [PMID: 25005924 DOI: 10.1007/s40273-014-0170-x] [Citation(s) in RCA: 488] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Discrete choice experiments (DCEs) are increasingly used in health economics to address a wide range of health policy-related concerns. OBJECTIVE Broadly adopting the methodology of an earlier systematic review of health-related DCEs, which covered the period 2001-2008, we report whether earlier trends continued during 2009-2012. METHODS This paper systematically reviews health-related DCEs published between 2009 and 2012, using the same database as the earlier published review (PubMed) to obtain citations, and the same range of search terms. RESULTS A total of 179 health-related DCEs for 2009-2012 met the inclusion criteria for the review. We found a continuing trend towards conducting DCEs across a broader range of countries. However, the trend towards including fewer attributes was reversed, whilst the trend towards interview-based DCEs reversed because of increased computer administration. The trend towards using more flexible econometric models, including mixed logit and latent class, has also continued. Reporting of monetary values has fallen compared with earlier periods, but the proportion of studies estimating trade-offs between health outcomes and experience factors, or valuing outcomes in terms of utility scores, has increased, although use of odds ratios and probabilities has declined. The reassuring trend towards the use of more flexible and appropriate DCE designs and econometric methods has been reinforced by the increased use of qualitative methods to inform DCE processes and results. However, qualitative research methods are being used less often to inform attribute selection, which may make DCEs more susceptible to omitted variable bias if the decision framework is not known prior to the research project. CONCLUSIONS The use of DCEs in healthcare continues to grow dramatically, as does the scope of applications across an expanding range of countries. There is increasing evidence that more sophisticated approaches to DCE design and analytical techniques are improving the quality of final outputs. That said, recent evidence that the use of qualitative methods to inform attribute selection has declined is of concern.
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Affiliation(s)
- Michael D Clark
- Department of Economics, University of Warwick, Coventry, CV4 7AL, UK,
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Benning TM, Dellaert BGC, Severens JL, Dirksen CD. The effect of presenting information about invasive follow-up testing on individuals' noninvasive colorectal cancer screening participation decision: results from a discrete choice experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:578-587. [PMID: 25128051 DOI: 10.1016/j.jval.2014.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Many national colorectal cancer screening campaigns have a similar structure. First, individuals are invited to take a noninvasive screening test, and, second, in the case of a positive screening test result, they are advised to undergo a more invasive follow-up test. The objective of this study was to investigate how much individuals' participation decision in noninvasive screening is affected by the presence or absence of detailed information about invasive follow-up testing and how this effect varies over screening tests. METHODS We used a labeled discrete choice experiment of three noninvasive colorectal cancer screening types with two versions that did or did not present respondents with detailed information about the possible invasive follow-up test (i.e., colonoscopy) and its procedure. We used data from 631 Dutch respondents aged 55 to 75 years. Each respondent received only one of the two versions (N = 310 for the invasive follow-up test information specification version, and N = 321 for the no-information specification version). RESULTS Mixed logit model results show that detailed information about the invasive follow-up test negatively affects screening participation decisions. This effect can be explained mainly by a decrease in choice shares for the most preferred screening test (a combined stool and blood sample test). Choice share simulations based on the discrete choice experiment indicated that presenting invasive follow-up test information decreases screening participation by 4.79%. CONCLUSIONS Detailed information about the invasive follow-up test has a negative effect on individuals' screening participation decisions in noninvasive colorectal cancer screening campaigns. This result poses new challenges for policymakers who aim not only to increase uptake but also to provide full disclosure to potential screening participants.
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Affiliation(s)
- Tim M Benning
- Institute of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands; CentERdata, Tilburg University, Tilburg, The Netherlands.
| | - Benedict G C Dellaert
- Department of Business Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Johan L Severens
- Institute of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands; CAPRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Harrison M, Rigby D, Vass C, Flynn T, Louviere J, Payne K. Risk as an Attribute in Discrete Choice Experiments: A Systematic Review of the Literature. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:151-70. [DOI: 10.1007/s40271-014-0048-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lagarde M, Pagaiya N, Tangcharoensathian V, Blaauw D. One size does not fit all: investigating doctors' stated preference heterogeneity for job incentives to inform policy in Thailand. HEALTH ECONOMICS 2013; 22:1452-69. [PMID: 23349119 DOI: 10.1002/hec.2897] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 10/29/2012] [Accepted: 11/29/2012] [Indexed: 05/26/2023]
Abstract
This study investigates heterogeneity in Thai doctors' job preferences at the beginning of their career, with a view to inform the design of effective policies to retain them in rural areas. A discrete choice experiment was designed and administered to 198 young doctors. We analysed the data using several specifications of a random parameter model to account for various sources of preference heterogeneity. By modelling preference heterogeneity, we showed how sensitivity to different incentives varied in different sections of the population. In particular, doctors from rural backgrounds were more sensitive than others to a 45% salary increase and having a post near their home province, but they were less sensitive to a reduction in the number of on-call nights. On the basis of the model results, the effects of two types of interventions were simulated: introducing various incentives and modifying the population structure. The results of the simulations provide multiple elements for consideration for policy-makers interested in designing effective interventions. They also underline the interest of modelling preference heterogeneity carefully.
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Affiliation(s)
- Mylene Lagarde
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
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Shirley L, Nightingale JM. Establishing the role of CT colonography within the Bowel Cancer Screening Programme. Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chen ZY, Shen HS, Luo MY, Duan CJ, Cai WL, Lu HB, Zhang GP, Liu Y, Liang JZ. Pilot study on efficacy of reduced cathartic bowel preparation with polyethylene glycol and bisacodyl. World J Gastroenterol 2013; 19:561-568. [PMID: 23382637 PMCID: PMC3558582 DOI: 10.3748/wjg.v19.i4.561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/16/2012] [Accepted: 01/07/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of reduced cathartic bowel preparation with 2 L polyethylene glycol (PEG)-4000 electrolyte solution and 10 mg bisacodyl enteric-coated tablets for computed tomographic colonography (CTC).
METHODS: Sixty subjects who gave informed consent were randomly assigned to study group A, study group B or the control group. On the day prior to CTC, subjects in study group A were given 20 mL 40% wt/vol barium sulfate suspension before 3 mealtimes, 60 mL 60% diatrizoate meglumine diluted in 250 mL water after supper, and 10 mg bisacodyl enteric-coated tablets 1 h before oral administration of 2 L PEG-4000 electrolyte solution. Subjects in study group B were treated identically to those in study group A, with the exception of bisacodyl which was given 1 h after oral PEG-4000. Subjects in the control group were managed using the same strategy as the subjects in study group A, but without administration of bisacodyl. Residual stool and fluid scores, the attenuation value of residual fluid, and discomfort during bowel preparation in the three groups were analyzed statistically.
RESULTS: The mean scores for residual stool and fluid in study group A were lower than those in study group B, but the differences were not statistically significant. Subjects in study group A showed greater stool and fluid cleansing ability than the subjects in study group B. The mean scores for residual stool and fluid in study groups A and B were lower than those in the control group, and were significantly different. There was no significant difference in the mean attenuation value of residual fluid between study group A, study group B and the control group. The total discomfort index during bowel preparation was 46, 45 and 45 in the three groups, respectively, with no significant difference.
CONCLUSION: Administration of 10 mg bisacodyl enteric-coated tablets prior to or after oral administration of 2 L PEG-4000 electrolyte solution enhances stool and fluid cleansing ability, and has no impact on the attenuation value of residual fluid or the discomfort index. The former is an excellent alternative for CTC colorectum cleansing
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Abstract
Current models of care emphasize the importance of including patients' values in the decision-making process. This is particularly important for decisions for which there are few data supporting a clear strategy or treatment choice. Constructing preferences for complex decisions requires that patients be able to consider multiple trade-offs between specific risks and benefits. Several marketing research techniques have been recently applied to heath care settings to facilitate this process. Most can be programmed to generate patients' preferences or priorities, which can then be used to improve patient-physician communication. In this article, we will describe some of the currently available approaches that have been successfully used in the health care setting. We provide case examples to illustrate the potential value of adopting each of these approaches in clinical practice.
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Affiliation(s)
- Liana Fraenkel
- Section of Rheumatology, Yale University School of Medicine, New Haven, CT 06520-8031, USA.
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Ghanouni A, Smith SG, Halligan S, Plumb A, Boone D, Magee MS, Wardle J, von Wagner C. Public perceptions and preferences for CT colonography or colonoscopy in colorectal cancer screening. PATIENT EDUCATION AND COUNSELING 2012; 89:116-121. [PMID: 22705250 DOI: 10.1016/j.pec.2012.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 05/03/2012] [Accepted: 05/18/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To examine public perceptions of and preferences for colonoscopy vs. CT colonography (CTC) as technologies for colorectal cancer (CRC) screening. METHODS Six discussion groups were carried out with 30 adults aged 49-60 years (60% female). Information about different aspects of the tests (e.g. sensitivity, practical issues) was presented sequentially using a semi-structured, step-by-step topic guide. Discussions were recorded and analyzed using framework analysis. RESULTS CTC was favored on the parameters of invasiveness, extra-colonic evaluation and interference with daily life, whereas sensitivity, avoiding false-positives and the capacity to remove polyps immediately were perceived to be important advantages of colonoscopy. Ultimately, there was no strong preference for either test: with 46% preferring colonoscopy vs. 42% for CTC. CONCLUSION With comprehensive information, colonoscopy and CTC were seen as having different advantages and disadvantages, yielding no clear preferences between the two. The sensitivity of colonoscopy was a decisive factor for some people, but the lower invasiveness of CTC was seen as an asset in the screening context. PRACTICE IMPLICATIONS CTC may be an acceptable alternative to colonoscopy in CRC screening. Healthcare professionals working in the screening context should be sensitive to the range of characteristics that can determine preferences for CRC screening tests.
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Affiliation(s)
- Alex Ghanouni
- Department of Epidemiology and Public Health, University College London, London, UK
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Calderwood AH, Wasan SK, Heeren TC, Schroy PC. Patient and Provider Preferences for Colorectal Cancer Screening: How Does CT Colonography Compare to Other Modalities? INTERNATIONAL JOURNAL OF CANCER PREVENTION 2011; 4:307-338. [PMID: 25237287 PMCID: PMC4165440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Patient and provider preferences toward CT colonography (CTC) remain unclear. The primary goals of this study were 1) to investigate patient preferences for one of the currently recommended CRC screening modalities and 2) to evaluate provider preferences before and after review of updated guidelines. METHODS Cross-sectional survey of ambulatory-care patients and providers in the primary care setting. Providers were surveyed before and after reviewing the 2008 guidelines by the American Cancer Society, US Multisociety Task Force on Colorectal Cancer and the American College of Radiology. RESULTS Of 100 patients surveyed, 59% preferred colonoscopy, 17% fecal occult blood testing (FOBT), 14% stool DNA (sDNA) testing, and 10% CTC (P <0.001). The majority of those whose first choice was a stool-based test chose the alternate stool-based test as their second choice over CTC or colonoscopy (P<0.0001). Patients who preferred colonoscopy chose accuracy (76%) and frequency of testing (10%) as the most important test features, whereas patients who preferred a stool-based test chose discomfort (52%) and complications (23%). Of 170 providers surveyed, 96% chose colonoscopy, 2% FOBT, and 1% FOBT with flexible sigmoidoscopy (FS) (p < 0.0001). No providers chose CTC or sDNA as their preferred option before reviewing guidelines, and 89% kept their preference after review of guidelines. As a default option for patients who declined colonoscopy, 44% of providers chose FOBT, 12% FOBT+FS, 4% CTC, and 37% deferred to patient preference before review of guidelines. Of the 33% of providers who changed their preference after review of guidelines, 46% recommended CTC. Accuracy was the most influential reason for provider test choice. CONCLUSIONS Patients and providers prefer colonoscopy for CRC screening. Revised guidelines endorsing the use of CTC are unlikely to change provider preferences but may influence choice of default strategies for patients who decline colonoscopy.
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Affiliation(s)
- Audrey H. Calderwood
- Boston University School of Medicine, Department of Medicine, Section of Gastroenterology, Boston, MA
| | - Sharmeel K. Wasan
- Boston University School of Medicine, Department of Medicine, Section of Gastroenterology, Boston, MA
| | - Timothy C. Heeren
- Boston University School of Public Health, Department of Biostatistics, Boston, MA
| | - Paul C. Schroy
- Boston University School of Medicine, Department of Medicine, Section of Gastroenterology, Boston, MA
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