14 Jan Patient Preferences for Cancer Screening
MedicalResearch.com Interview with:
Dr Jonathan Banks
Programme Manager: The Discovery Research Programme
Centre for Academic Primary Care
NIHR School for Primary Care Research
School of Social and Community Medicine
University of Bristol Bristol BS8 2PS
MedicalResearch.com: What are the main findings of the study?
Dr. Banks: We asked members of the public attending their local general practice or
primary care centre to consider a series of hypothetical scenarios or
vignettes which depicted cancer symptoms, their risk of cancer and the
investigative processes involved in testing for cancer. We wanted to
measure the point at which the risk of cancer outweighed the burden and
inconvenience of testing in relation to lung, colorectal and pancreas
cancers. Most people, around 88%, opted for testing even at the lowest risk
of cancer which in our vignettes was 1%. Further analyses showed variation
between cancers with fewer people opting for testing for colorectal cancer
at a low (1%) risk and more people choosing to be tested for all cancers in
the 60-69 age group.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Banks: We did expect to see more a gradient across all the cancers with more
people choosing to be tested at higher risk levels. However, there was no
strong evidence of such a gradient except in the case of colorectal cancer
and respondents cited the demands and unpleasantness of the diagnostic test
(colonoscopy) as influencing their decision. We were pleasantly surprised
at the numbers of participants we were able to recruit to the study, we had
thought that there may have been some resistance to discussing and thinking
about cancer symptoms in this way but the public were very responsive to
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Banks: Clinical guidelines in the UK highlight the importance of including
patients in decision making around referral for testing. We think that the
way the public engaged with this study and the considered responses that
they gave which are reflected in the subtle variations in choice around
colorectal cancer and age suggest that clinicians at the primary care level
can be bolder in incorporating patient views and preferences into the
decision making process. On a wider level we feel that these findings
should also feed into the ongoing revision of cancer referral guidelines.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Banks: We feel that it would be valuable to measure GP preferences for referral
and compare these to the patient viewpoint.
Preferences for cancer investigation: a vignette-based study of primary-care attendees
Dr Jonathan Banks PhD,Sandra Hollinghurst PhD,Lin Bigwood MA,Prof Tim J Peters PhD,Fiona M Walter MD,Prof Willie Hamilton MD
The Lancet Oncology – 14 January 2014