背景:结直肠癌(CRC)是第二致命的癌症,到2020年,全球估计有190万例病例和90万人死亡。尽管有筛查测试,他们的摄取仍然次优。然而,在体内寻找癌症特异性标记物迹象的基于血液的测试越来越多地可用作更具侵入性的癌症测试的替代方法。与现有测试相比,血液检测对CRC的益处包括不需要进行预测前准备,大便处理,以及饮食或药物限制。
目的:本研究旨在探讨人群对CRC筛查试验的偏好,专注于血液测试,并探讨了影响试验摄取的因素。
方法:我们使用了混合方法方法,结合半结构化访谈和离散选择实验(DCE)调查。使用主题分析对访谈进行分析,以确定CRC筛查测试的显着属性。这些属性为DCE调查的设计提供了信息。使用混合logit和混合-混合多项logit模型分析DCE数据。
结果:来自30名参与者的定性发现显示,由于他们认为风险低,参与者更喜欢血液检测,轻微的疼痛,并且易于收集样品。然而,也表达了对测试精度较低的担忧。DCE调查由1189名参与者完成。在混合logit模型中,参与者对血液检测的偏好高于2天的粪便检测.混合-混合多项式Logit模型确定了2类,强大的支持者和弱小的支持者,用于CRC筛查。软弱的支持者,但不是强有力的支持者,对血液测试的偏好更高。女人,华裔,40至60岁的人更有可能是软弱的支持者。这两个模型都强调了成本和测试敏感性对参与者偏好的高度影响。从2天的基于粪便的测试过渡到基于血液的测试,假设国家筛查计划的基本价格为新加坡5美元(3.75美元),估计有可能使相对摄取增加5.9%(95%CI3.6%-8.2%)。
结论:这些发现有助于我们对CRC筛查偏好的理解,并提供对驱动测试摄取的因素的见解。这项研究强调了基于血液的测试的感知优势,并确定了有关其准确性的关注领域。当提供基于血液的测试时,需要进一步的研究来确定摄取率的实际增加。
BACKGROUND: Colorectal cancer (CRC) is the second most deadly form of cancer, inducing an estimated 1.9 million incidence cases and 0.9 million deaths worldwide in 2020. Despite the availability of screening tests, their uptake remains suboptimal. However, blood-based tests that look for signs of cancer-specific markers in the body are increasingly available as an alternative for more invasive tests for cancer. Compared with existing tests, the benefits of blood-based tests for CRC include not needing pretest preparation, stool handling, and dietary or medication restrictions.
OBJECTIVE: This
study aims to explore the population\'s preferences for CRC screening tests, with a focus on blood-based tests, and investigate the factors influencing test uptake.
METHODS: We used a mixed methods approach, combining semistructured interviews and a discrete choice experiment (DCE) survey. Interviews were analyzed using thematic analysis to identify salient attributes for CRC screening tests. These attributes informed the design of the DCE survey. The DCE data were analyzed using mixed logit and mixed-mixed multinomial logit models.
RESULTS: Qualitative findings from 30 participants revealed that participants preferred blood-based tests due to their perceived low risk, minimal pain, and ease of sample collection. However, concerns about the test\'s lower accuracy were also expressed. The DCE survey was completed by 1189 participants. In the mixed logit model, participants demonstrated a stronger preference for blood-based tests over a 2-day stool-based test. The mixed-mixed multinomial logit model identified 2 classes, strong supporters and weak supporters, for CRC screening. Weak supporters, but not strong supporters, had a higher preference for blood-based tests. Women, ethnic Chinese, and people aged 40 to 60 years were more likely to be weak supporters. Both models highlighted the high influence of cost and test sensitivity on participants\' preferences. Transitioning from a 2-day stool-based test to a blood-based test, assuming a national screening program at a base price of Singapore $5 (US $3.75), was estimated to have the potential to increase the relative uptake by 5.9% (95% CI 3.6%-8.2%).
CONCLUSIONS: These findings contribute to our understanding of CRC screening preferences and provide insights into the factors driving test uptake. This
study highlights the perceived advantages of blood-based tests and identifies areas of concern regarding their accuracy. Further research is needed to determine the actual increase in uptake rate when blood-based tests are made available.