Evaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy Process

dc.contributor.authorHyams, Travis
dc.contributor.authorGolden, Bruce
dc.contributor.authorSammarco, John
dc.contributor.authorSultan, Shahnaz
dc.contributor.authorKing-Marshall, Evelyn
dc.contributor.authorWang, Min Qi
dc.contributor.authorCurbow, Barbara
dc.description.abstractIn 2021, the United States Preventive Services Task Force updated their recommendation, stating that individuals ages 45-49 should initiate screening for colorectal cancer. Since several screening strategies are recommended, making a shared decision involves including an individual’s preferences. Few studies have included individuals under age 50. In this study, we use a multicriteria decision analysis technique called the Analytic Hierarchy Process to explore preferences for screening strategies and evaluate whether preferences vary by age. Participants evaluated a hierarchy with 3 decision alternatives (colonoscopy, fecal immunochemical test, and computed tomography colonography), 3 criteria (test effectiveness, the screening plan, and features of the test) and 7 sub-criteria. We used the linear fit method to calculate consistency ratios and the eigenvector method for group preferences. We conducted sensitivity analysis to assess whether results are robust to change and tested differences in preferences by participant variables using chi-square and analysis of variance. Of the 579 individuals surveyed, 556 (96%) provided complete responses to the AHP portion of the survey. Of these, 247 participants gave responses consistent enough (CR < 0.18) to be included in the final analysis. Participants that were either white or have lower health literacy were more likely to be excluded due to inconsistency. Colonoscopy was the preferred strategy in those < 50 and fecal immunochemical test was preferred by those over age 50 (p = 0.002). These results were consistent when we restricted analysis to individuals ages 45-55 (p = 0.011). Participants rated test effectiveness as the most important criteria for making their decision (weight = 0.555). Sensitivity analysis showed our results were robust to shifts in criteria and sub-criteria weights. We reveal potential differences in preferences for screening strategies by age that could influence the adoption of screening programs to include individuals under age 50. Researchers and practitioners should consider at-home interventions using the Analytic Hierarchy Process to assist with the formulation of preferences that are key to shared decision-making. The costs associated with different preferences for screening strategies should be explored further if limited resources must be allocated to screen individuals ages 45-49.en_US
dc.identifier.citationHyams, T., Golden, B., Sammarco, J. et al. Evaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy Process. BMC Health Serv Res 21, 754 (2021).en_US
dc.publisherSpringer Natureen_US
dc.relation.isAvailableAtSchool of Public Healthen_us
dc.relation.isAvailableAtPublic & Community Healthen_us
dc.relation.isAvailableAtDigital Repository at the University of Marylanden_us
dc.relation.isAvailableAtUniversity of Maryland (College Park, MD)en_us
dc.subjectColorectal canceren_US
dc.subjectMulticriteria decision analysisen_US
dc.subjectMedical decision makingen_US
dc.titleEvaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy Processen_US


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