Comparing 3 Values Clarification Methods for Colorectal Cancer Screening Decision-Making: A Randomized Trial in the US and Australia
Comparing 3 Values Clarification Methods for Colorectal Cancer Screening Decision-Making: A Randomized Trial in the US and Australia
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DOI：
10.1007/s11606-013-2701-0
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发表时间：
2014-03-01
影响因子：
5.7
通讯作者：
Pignone, Michael
中科院分区：
文献类型：
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作者：
Brenner, Alison;Howard, Kirsten;Pignone, Michael
目的：比较三种价值澄清方法（VCM）的效果：资产负债表；评级和排名；以及美国和澳大利亚成年人关于结肠直肠癌筛查决策的离散选择实验（DCE）。使用由美国和澳大利亚的一个调查研究组织管理的在线小组，我们招募了年龄在50-75岁、患CRC平均风险的成年人进行在线调查。那些符合条件的人被随机分配到三个VCM任务中的一个。根据五个关键属性描述了CRC筛查方案：降低CRC发病率和死亡率的风险；筛选试验的性质；检查频率;筛查并发症；以及需要结肠镜检查的机会（作为初始或后续检查）。主要结果包括自我报告的最重要属性和按VCM和按国家进行的未标记筛选试验偏好，在VCM之后进行评估。共纳入920名参与者；51%是澳大利亚人；平均年龄59.0岁；白人占87.7%；34.2%的人拥有四年制大学学历；42.8%的家庭年收入低于4.5万美元；44.9%的人接受过结直肠癌筛查。最重要的属性在VCM组之间存在差异：评级和排名组比资产负债表组（54.7%）或DCE组（49.3%）更有可能选择风险降低作为最重要的属性（69.8%），p < 0.0001；最重要的属性没有因国家而异（p = 0.236）。粪便隐血试验（FOBT）样试验是最常见的首选试验（55.9%）。未标记的测试选择在VCM上没有显著差异。澳大利亚人更喜欢FOBT（澳大利亚66.2%对美国45.1%,OR 2.4, 95% CI 1.8, 3.1）。少数参与者赞成不进行筛查（美国：9.2%，澳大利亚：6.2%）。筛选测试属性的重要性因VCM而异，但不因国家而异。澳大利亚人比美国人更喜欢FOBT，但两国的测试偏好不同。
PURPOSE: To compare the effects of three methods of values clarification (VCM): balance sheet; rating and ranking; and a discrete choice experiment (DCE) on decision-making about colorectal cancer (CRC) screening among adults in the US and Australia.Using online panels managed by a survey research organization in the US and Australia, we recruited adults ages 50-75 at average risk for CRC for an online survey. Those eligible were randomized to one of the three VCM tasks. CRC screening options were described in terms of five key attributes: reduction in risk of CRC incidence and mortality; nature of the screening test; screening frequency; complications from screening; and chance of requiring a colonoscopy (as initial or follow-up testing). Main outcomes included self-reported most important attribute and unlabeled screening test preference by VCM and by country, assessed after the VCM.A total of 920 participants were enrolled; 51 % were Australian; mean age was 59.0; 87.0 % were white; 34.2 % had a 4-year college degree; 42.8 % had household incomes less than $45,000 USD per year; 44.9 % were up to date with CRC screening. Most important attribute differed across VCM groups: the rating and ranking group was more likely to choose risk reduction as most important attribute (69.8 %) than the balance sheet group (54.7 %) or DCE (49.3 %), p < 0.0001; most important attribute did not vary by country (p = 0.236). The fecal occult blood test (FOBT)-like test was the most frequently preferred test overall (55.9 %). Unlabeled test choice did not differ meaningfully by VCM. Australians were more likely to prefer the FOBT (AU 66.2 % vs. US 45.1 %, OR 2.4, 95 % CI 1.8, 3.1). Few participants favored no screening (US: 9.2 %, AU: 6.2 %).Screening test attribute importance varied by VCM, but not by country. FOBT was more commonly preferred by Australians than by Americans, but test preferences were heterogeneous in both countries.