Determining Filipinos' Preferences for Colorectal Cancer Screening Tests: Insights From a Choice-Based Conjoint Analysis

Abstract

Introduction: Filipinos in the U.S. have worse colorectal cancer screening rates and outcomes than non-Hispanic Whites, despite 85% of Filipinos being proficient in English and having insurance rates, education, and incomes that exceed those of the general population. To begin to address this disparity, the authors used conjoint analysis-a method that assesses complex decision making-to better understand Filipinos' preferences for the different colorectal cancer screening test options.

Methods: The authors conducted a conjoint analysis survey among unscreened Filipinos aged ≥40 years at average risk for colorectal cancer to determine the relative importance of screening test attributes in their decision making (e.g., modality, effectiveness at reducing colorectal cancer risk, bowel prep). The authors also performed simulations to estimate the proportion of people who would prefer to do an annual fecal immunochemical test or colonoscopy every 10 years for their screening.

Results: Overall, 105 Filipinos completed the survey; most respondents were female (74.3%) and aged 40-49 years (84.8%). The authors observed that test modality was the most important factor in respondents' decision making. After conducting simulations using the conjoint analysis data, the authors noted that 70 (66.7%) Filipinos preferred to do an annual fecal immunochemical test for their screening, whereas 35 (33.3%) wanted to do a colonoscopy every 10 years.

Conclusions: The authors found that 2 in 3 Filipinos prefer fecal immunochemical test to colonoscopy for their colorectal cancer screening. To address colorectal cancer disparities in the Filipino community, investigators, health systems, public health agencies, and community organizations need to develop culturally tailored, sustainable interventions, and such programs may want to focus on improving education on and access to fecal immunochemical test.

Keywords: Filipino; colorectal cancer screening; disparities; patient preference.

Figure 1

Sample conjoint exercise where participants consider hypothetical CRC screening tests side by side and decide which one, if any, they would be most likely to do. Participants were shown a total of 9 vignettes, and they were able to hover their mouse over bolded text for further information. Note: whereas the original analyses focused on all MSTF-recommended CRC screening tests, this study focused on examining those who preferred the MSTF Tier 1–recommended tests—annual FIT versus colonoscopy every 10 years. CRC, colorectal cancer; CT, computed tomography; FIT, fecal immunochemical test; MSTF, Multi-Society Task Force.

Figure 2

Data from simulations using conjoint analysis data assessing the proportion of respondents who would prefer each MSTF Tier 1–recommended test (N=105). FIT, fecal immunochemical test; MSTF, Multi-Society Task Force.