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Patients & healthcare professionals values regarding true and false-positive diagnosis when colorectal cancer screening by CT colonography : discrete choice experiment
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Boone, David L., Mallett, S., Zhu, S., Yao, G. L., Bell, N., Ghanouni, A., von Wagner, C., Taylor, S. A., Altman, Douglas G., Lilford, Richard and Halligan, S. (2013) Patients & healthcare professionals values regarding true and false-positive diagnosis when colorectal cancer screening by CT colonography : discrete choice experiment. PLoS One, 8 (12). e80767. ISSN 1932-6203.
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Official URL: http://dx.doi.org/10.1371/journal.pone.0080767
Abstract
PURPOSE:
To establish the relative weighting given by patients and healthcare professionals to gains in diagnostic sensitivity versus loss of specificity when using CT colonography (CTC) for colorectal cancer screening.
MATERIALS AND METHODS:
Following ethical approval and informed consent, 75 patients and 50 healthcare professionals undertook a discrete choice experiment in which they chose between "standard" CTC and "enhanced" CTC that raised diagnostic sensitivity 10% for either cancer or polyps in exchange for varying levels of specificity. We established the relative increase in false-positive diagnoses participants traded for an increase in true-positive diagnoses.
RESULTS:
Data from 122 participants were analysed. There were 30 (25%) non-traders for the cancer scenario and 20 (16%) for the polyp scenario. For cancer, the 10% gain in sensitivity was traded up to a median 45% (IQR 25 to >85) drop in specificity, equating to 2250 (IQR 1250 to >4250) additional false-positives per additional true-positive cancer, at 0.2% prevalence. For polyps, the figure was 15% (IQR 7.5 to 55), equating to 6 (IQR 3 to 22) additional false-positives per additional true-positive polyp, at 25% prevalence. Tipping points were significantly higher for patients than professionals for both cancer (85 vs 25, p<0.001) and polyps (55 vs 15, p<0.001). Patients were willing to pay significantly more for increased sensitivity for cancer (pā=ā0.021).
CONCLUSION:
When screening for colorectal cancer, patients and professionals believe gains in true-positive diagnoses are worth much more than the negative consequences of a corresponding rise in false-positives. Evaluation of screening tests should account for this.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Colon (Anatomy) -- Cancer -- Diagnosis , Colon (Anatomy) -- Tomography | ||||||||
Journal or Publication Title: | PLoS One | ||||||||
Publisher: | Public Library of Science | ||||||||
ISSN: | 1932-6203 | ||||||||
Official Date: | 9 December 2013 | ||||||||
Dates: |
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Volume: | 8 | ||||||||
Number: | 12 | ||||||||
Article Number: | e80767 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 8 August 2016 | ||||||||
Date of first compliant Open Access: | 8 August 2016 | ||||||||
Funder: | National Institute for Health Research (Great Britain) (NIHR) | ||||||||
Grant number: | RP-PG-0407-10338 (NIHR) |
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