Investigating the Heterogeneity in Women's Preferences for Breast Screening: Does the Communication of Risk Matter?

Abstract

Background: The relative benefits and risks of screening programs for breast cancer have been extensively debated.

Objectives: To quantify and investigate heterogeneity in women's preferences for the benefits and risks of a national breast screening program (NBSP) and to understand the effect of risk communication format on these preferences.

Methods: An online discrete choice experiment survey was designed to elicit preferences from female members of the public for an NBSP described by three attributes (probability of detecting a cancer, risk of unnecessary follow-up, and out-of-pocket screening costs). Survey respondents were randomized to one of two surveys, presenting risk either as percentages only or as icon arrays and percentages. Respondents were required to choose between two hypothetical NBSPs or no screening in 11 choice sets generated using a Bayesian D-efficient design. The trade-offs women made were analyzed using heteroskedastic conditional logit and scale-adjusted latent class models.

Results: A total of 1018 women completed the discrete choice experiment (percentages-only version = 507; icon arrays and percentages version = 511). The results of the heteroskedastic conditional logit model suggested that, on average, women were willing-to-accept 1.72 (confidence interval 1.47-1.97) additional unnecessary follow-ups and willing-to-pay £79.17 (confidence interval £66.98-£91.35) for an additional cancer detected per 100 women screened. Latent class analysis indicated substantial heterogeneity in preferences with six latent classes and three scale classes providing the best fit. The risk communication format received was not a predictor of scale class or preference class membership.

Conclusions: Most women were willing to trade-off the benefits and risks of screening, but decision makers seeking to improve uptake should consider the disparate needs of women when configuring services.

Keywords: breast screening; discrete choice experiment; risk; willingness-to-pay.