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Research

Public preferences for using quantitative faecal immunochemical test versus colonoscopy as diagnostic test for colorectal cancer: evidence from an online survey

Christian von Wagner, Wouter Verstraete, Yasemin Hirst, Brian D Nicholson, Sandro T Stoffel and Helga Laszlo
BJGP Open 2020; 4 (1): bjgpopen20X101007. DOI: https://doi.org/10.3399/bjgpopen20X101007
Christian von Wagner
1 Reader, Research Department of Behavioural Science and Health, University College London, London, UK
PhD
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  • ORCID record for Christian von Wagner
  • For correspondence: c.wagner{at}ucl.ac.uk
Wouter Verstraete
2 Research Assistant Research Department of Behavioural Science and Health, University College London, London, UK
MSC
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Yasemin Hirst
3 Senior Research Fellow, Research Department of Behavioural Science and Health, University College London, London, UK
PhD
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Brian D Nicholson
4 Senior Clinical Researcher, Nuffield Dept Primary Care Health Sciences, University of Oxford, Oxford, UK
BSc, MSc, MBChB, MRCGP
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Sandro T Stoffel
5 Research Associate, Research Department of Behavioural Science and Health, University College London, London, UK
6 European Center of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
PhD
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Helga Laszlo
7 Programme Manager, UCLH Cancer Collaborative, University College London Hospitals, London, UK
MD
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    Figure 1. Flow through the survey
  • Figure 2.
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    Figure 2. Dynamic forced-choice staircases

    CC = colonoscopy. CRC = colorectal cancer. FIT = faecal immunochemical test. Max = maximum.

  • Figure 3.
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    Figure 3. Switching point for responders’ faecal immunochemical test (FIT) preference over colonoscopy (CC) (n = 1057).

    Those who preferred FIT over CC in choice one were asked to choose between a CC that misses 1% of colorectal cancers (CRCs) and an alternative FIT that misses 2% of CRCs in choice 2. Participants who kept choosing FIT over CC were presented with new scenarios in which the number of CRCs missed by FIT increased constantly by 2%. In the final scenario, FIT was reported to miss 10% of CRCs. The method let the authors infer the maximum acceptable number of CRCs missed by FIT.

Tables

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    Table 1. Study sample‘s sociodemographic variables and symptoms in the last three weeks (n = 1057)
    Aged 40–49 years, n (%)Aged 0–59 years, n (%)Total, n (%)P value
    Sex
     Men281 (54.5)283 (52.3)564 (53.4)0.484
     Women235 (45.5)258 (47.7)493 (46.6)
    Marital status
     Single or divorced or separated166 (32.2)196 (36.2)362 (34.2)0.165
     Married or cohabiting350 (67.8)345 (63.8)695 (65.8)
    Education
     No A-levels170 (32.9)225 (41.6)395 (37.4)0.004
     A-levels346 (67.1)316 (58.4)662 (62.6)
    Paid employment
     No109 (21.1)201 (37.2)310 (29.3)<0.001
     Yes407 (78.9)340 (62.8)747 (70.7)
    Ethnic group
     White461 (89.3)510 (94.3)971 (91.9)0.003
     BAME55 (10.7)31 (5.7)86 (8.1)
    Numeracy question
     Wrong227 (44.0)241 (44.5)468 (44.3)0.856
     Correct289 (56.0)300 (55.5)589 (55.7)
    Own perceived risk
     Lower87 (16.9)91 (16.8)178 (16.8)0.436
     Same369 (71.5)400 (73.9)769 (72.8)
     Higher60 (11.6)50 (9.2)110 (10.4)
    Constipation
     Not at all429 (83.1)424 (78.7)853 (80.9)0.065
     Occ/frequ87 (16.9)115 (21.3)202 (19.1)
    Diarrhoea
     Not at all411 (80.0)430 (79.6)841 (79.8)0.893
     Occ/frequ103 (20.0)110 (20.4)213 (20.2)
    Bowel incontinence
     Not at all500 (97.3)521 (96.5)1021 (96.9)0.459
     Occ/frequ14 (2.7)19 (3.5)33 (3.1)
    Indigestion
     Not at all533 (79.8)491 (73.9)1024 (76.8)0.024
     Occ/frequ245 (20.2)270 (26.1)515 (23.2)
    • BAME = black and minority ethnic. Occ/frequ = occassionally or frequently

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    Table 2. Multivariate models explaining not wanting to have CC or FIT and switching point
    Logistic model: not wanting any testOrdinal model: switching point
    Odds ratio 95% CI Odds ratio 95% CI
    Sex
    MaleRefRef
    Female0.8130.555 to 1.1921.4131.109 to 1.800a
    Age, years
    40–49RefRef
    50–590.8210.564 to 1.1941.0080.792 to 1.282
    Education
    No A-levelsRefRef
    A-levels0.8640.586 to 1.2741.2220.950 to 1.572
    Paid employment
    YesRefRef
    No1.2940.865 to 1.9381.2080.925 to 1.579
    Marital status
    Single or divorced or separatedRefRef
    Married or cohabiting0.9370.640 to 1.3730.8070.629 to 1.035
    Ethnic group
    WhiteRefRef
    BAME3.4922.071 to 5.888a 0.6760.402 to 1.134
    Numeracy question
    CorrectRefRef
    Wrong2.5391.737 to 3.712a 0.7360.576 to 0.940b
    Own perceived risk
    LowerRefRef
    Same1.1780.700 to 1.9810.9830.719 to 1.343
    Higher2.3521.199 to 4.617b 0.5460.336 to 0.887b
    Constipation
    Not at allRefRef
    Occasionally1.0560.637 to 1.7510.8480.614 to 1.169
    Diarrhoea
    Not at allRefRef
    Occasionally0.8560.514 to 1.4240.9390.691 to 1.277
    Bowel incontinence
    Not at allRefRef
    Occasionally0.3960.087 to 1.8100.5880.296 to 1.166
    Indigestion
    Not at allRefRef
    Occasionally0.7690.476 to 1.2421.5721.178 to 2.097a
    1048903
    • a P<0.01. b P<0.05.

    • BAME = black and minority ethnic. CI = confidence intervals. Ref = reference.

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Public preferences for using quantitative faecal immunochemical test versus colonoscopy as diagnostic test for colorectal cancer: evidence from an online survey
Christian von Wagner, Wouter Verstraete, Yasemin Hirst, Brian D Nicholson, Sandro T Stoffel, Helga Laszlo
BJGP Open 2020; 4 (1): bjgpopen20X101007. DOI: 10.3399/bjgpopen20X101007

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Public preferences for using quantitative faecal immunochemical test versus colonoscopy as diagnostic test for colorectal cancer: evidence from an online survey
Christian von Wagner, Wouter Verstraete, Yasemin Hirst, Brian D Nicholson, Sandro T Stoffel, Helga Laszlo
BJGP Open 2020; 4 (1): bjgpopen20X101007. DOI: 10.3399/bjgpopen20X101007
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Keywords

  • diagnostic tests
  • preference elicitation
  • choice experiment
  • colorectal neoplasms
  • primary health care
  • surveys and questionnaires

More in this TOC Section

  • Perceptions and practices of UK GPs towards youth vaping: a questionnaire-based study
  • Exploring the barriers and facilitators to discussing social media in primary care for young adults with mental health concerns: a qualitative study
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