Assessing Stated Preferences for Colorectal Cancer Screening: A Critical Systematic Review of Discrete Choice Experiments

Background It is well established that screening is effective in reducing the incidence and mortality associated with colorectal cancer (CRC). National screening programs have been implemented in many countries; however, uptake remains an issue. Understanding patient preferences may assist in shaping screening programs and tailoring information about screening tests. Objective Our objective was to undertake a systematic review of discrete choice experiments (DCEs) of CRC screening. Methods A systematic review of DCEs of CRC screening was undertaken in an average-risk general population. The methodological qualities of the studies were assessed using a standard checklist outlining best practice for conjoint studies. Results Nine studies met the selection criteria. Meta-analysis was not possible due to the heterogeneity of the data and methods. However, in eight studies, attributes describing accuracy and/or clinical effectiveness were reported to be statistically significant. We also found that individuals were willing to trade-off other attributes such as an increased risk of complications to gain greater clinical benefits. Screening was also preferred to non-screening by the majority of respondents, regardless of the test used. Conclusions Understanding and incorporating individuals' preferences in decision making is increasingly considered essential in the health field. Data from DCEs can provide valuable insights into the trade-offs individuals are willing to undertake in respect to CRC screening. Such insights can be used by decision makers to identify screening tests that could maximize informed uptake. It is likely that, with better reporting and evolving methodology, the contribution that DCEs can make to such debates will increase.