Patients’ & Healthcare Professionals’ Values Regarding True- & False-Positive Diagnosis when Colorectal Cancer Screening by CT Colonography: Discrete Choice Experiment

Darren Boone; Susan Mallett; Shihua Zhu; Guiqing Lily Yao; Nichola Bell; Alex Ghanouni; Christian von Wagner; Stuart A Taylor; Douglas G Altman; Richard Lilford; Steve Halligan

doi:10.1371/journal.pone.0080767

Patients’ & Healthcare Professionals’ Values Regarding True- & False-Positive Diagnosis when Colorectal Cancer Screening by CT Colonography: Discrete Choice Experiment

Darren Boone, Susan Mallett, Shihua Zhu, Guiqing Lily Yao, Nichola Bell, Alex Ghanouni, Christian von Wagner, Stuart A Taylor, Douglas G Altman, Richard Lilford, Steve Halligan

Applied Health Sciences

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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 (p = 0.021).

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.

Original language	English
Article number	e80767
Journal	PLoS ONE
Volume	8
Issue number	12
DOIs	https://doi.org/10.1371/journal.pone.0080767
Publication status	Published - Dec 2013

Keywords

Colonic Polyps
Colonography, Computed Tomographic
Colorectal Neoplasms
Early Detection of Cancer
Humans
Patients
Sensitivity and Specificity

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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© 2013 Boone et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Boone, D., Mallett, S., Zhu, S., Yao, G. L., Bell, N., Ghanouni, A., von Wagner, C., Taylor, S. A., Altman, D. G., Lilford, R., & Halligan, S. (2013). Patients’ & Healthcare Professionals’ Values Regarding True- & False-Positive Diagnosis when Colorectal Cancer Screening by CT Colonography: Discrete Choice Experiment . PLoS ONE, 8(12), Article e80767. https://doi.org/10.1371/journal.pone.0080767

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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 (p = 0.021).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.",

keywords = "Colonic Polyps, Colonography, Computed Tomographic, Colorectal Neoplasms, Early Detection of Cancer, Humans, Patients, Sensitivity and Specificity",

author = "Darren Boone and Susan Mallett and Shihua Zhu and Yao, {Guiqing Lily} and Nichola Bell and Alex Ghanouni and {von Wagner}, Christian and Taylor, {Stuart A} and Altman, {Douglas G} and Richard Lilford and Steve Halligan",

year = "2013",

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doi = "10.1371/journal.pone.0080767",

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Boone, D, Mallett, S, Zhu, S, Yao, GL, Bell, N, Ghanouni, A, von Wagner, C, Taylor, SA, Altman, DG, Lilford, R & Halligan, S 2013, 'Patients’ & Healthcare Professionals’ Values Regarding True- & False-Positive Diagnosis when Colorectal Cancer Screening by CT Colonography: Discrete Choice Experiment ', PLoS ONE, vol. 8, no. 12, e80767. https://doi.org/10.1371/journal.pone.0080767

TY - JOUR

T1 - Patients’ & Healthcare Professionals’ Values Regarding True- & False-Positive Diagnosis when Colorectal Cancer Screening by CT Colonography

T2 - Discrete Choice Experiment

AU - Boone, Darren

AU - Mallett, Susan

AU - Zhu, Shihua

AU - Yao, Guiqing Lily

AU - Bell, Nichola

AU - Ghanouni, Alex

AU - von Wagner, Christian

AU - Taylor, Stuart A

AU - Altman, Douglas G

AU - Lilford, Richard

AU - Halligan, Steve

PY - 2013/12

Y1 - 2013/12

N2 - 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 (p = 0.021).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.

AB - 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 (p = 0.021).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.

KW - Colonic Polyps

KW - Colonography, Computed Tomographic

KW - Colorectal Neoplasms

KW - Early Detection of Cancer

KW - Humans

KW - Patients

KW - Sensitivity and Specificity

U2 - 10.1371/journal.pone.0080767

DO - 10.1371/journal.pone.0080767

M3 - Article

C2 - 24349014

SN - 1932-6203

VL - 8

JO - PLoS ONE

JF - PLoS ONE

IS - 12

M1 - e80767

ER -

Patients’ & Healthcare Professionals’ Values Regarding True- & False-Positive Diagnosis when Colorectal Cancer Screening by CT Colonography: Discrete Choice Experiment

Abstract

Keywords

UN SDGs

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