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. 2022 Aug;42(6):783-794.
doi: 10.1177/0272989X211073320. Epub 2022 Jan 22.

A Procedure for Eliciting Women's Preferences for Breast Cancer Screening Frequency

Emily Grayek  1 , Yanran Yang  1 , Baruch Fischhoff  1   2 , Karen E Schifferdecker  3 , Steven Woloshin  3 , Karla Kerlikowske  4   5 , Diana L Miglioretti  6 , Anna N A Tosteson  3
Affiliations

A Procedure for Eliciting Women's Preferences for Breast Cancer Screening Frequency

Emily Grayek et al. Med Decis Making. 2022 Aug.

Abstract

Background: We evaluate the construct validity of a proposed procedure for eliciting lay preferences among health care policy options, suited for structured surveys. It is illustrated with breast cancer screening, a domain in which people may have heterogeneous preferences.

Methods: Our procedure applies behavioral decision research principles to eliciting preferences among policy options expressed in quantitative terms. Three-hundred women older than 18 y without a history of breast cancer were recruited through Amazon MTurk. Participants evaluated 4 screening options for each of 4 groups of women, with varying risk of breast cancer. Each option was characterized by estimates of 3 primary outcomes: breast cancer deaths, false alarms, and overdiagnosis resulting in unnecessary treatment of cancers that would not progress. These estimates were based on those currently being developed by the Breast Cancer Surveillance Consortium. For each risk group, participants stated how frequently they would wish to receive screening, if the predicted outcomes applied to them.

Results: A preregistered test found that preferences were robust enough to be unaffected by the order of introducing and displaying the outcomes. Other tests of construct validity also suggested that respondents generally understood the task and expressed consistent preferences. Those preferences were related to participants' age and mammography history but not to measures of their numeracy, subjective numeracy, or demographics. There was considerable heterogeneity in their preferences.

Conclusions: Members of the public can be engaged more fully in informing future screening guidelines if they evaluate the screening options characterized by the expected health outcomes expressed in quantitative terms. We offer and evaluate such a procedure, in terms of its construct validity with a diverse sample of women.

Highlights: A novel survey method for eliciting lay preferences for breast cancer screening is proposed and evaluated in terms of its construct validity.Participants were generally insensitive to irrelevant task features (e.g., order of presentation) and sensitive to relevant ones (e.g., quantitative estimates of breast cancer risk, harms from screening).The proposed method elicits lay preferences in terms that can inform future screening guidelines, potentially improving communication between the public and policy makers.

Keywords: breast cancer screening; clinical guidelines; mammography; preference elicitation; risk communication; survey methodology.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
The tables used to display outcome information to elicit women's preferences for frequency of mammography screening. Women received one of six random surveys which differed in the order in which information was presented. The risk tables were presented in a random order for each participant. Note. For the Very Low Risk and Low Risk tables, Every Year was a dominated choice. For the Medium Risk and High Risk tables Every 2 Years was a dominated choice. Dominated choices occur when two rows have the same chance of breast cancer death, but differ in the other outcomes.
See this image and copyright information in PMC

References

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