Using willingness-to-pay to establish patient preferences for cancer testing in primary care
Hollinghurst, S; Banks, J; Bigwood, L; et al.Walter, F; Hamilton, W; Peters, TJ
Date: 9 August 2016
Journal
BMC Medical Informatics and Decision Making
Publisher
BioMed Central
Publisher DOI
Abstract
Background
Shared decision making is a stated aim of several healthcare systems. In the area of cancer, patients’
views have informed policy on screening and treatment but there is little information about their
views on diagnostic testing in relation to symptom severity.
Methods
We used the technique of willingness-to-pay to ...
Background
Shared decision making is a stated aim of several healthcare systems. In the area of cancer, patients’
views have informed policy on screening and treatment but there is little information about their
views on diagnostic testing in relation to symptom severity.
Methods
We used the technique of willingness-to-pay to determine public preferences around diagnostic
testing for colorectal, lung, and pancreatic cancer in primary care in the UK. Participants were
approached in general practice waiting rooms and asked to complete a two-stage electronic survey
that described symptoms of cancer, the likelihood that the symptoms indicate cancer, and
information about the appropriate diagnostic test. Part 1 asked for a binary response (yes/no) as to
whether they would choose to have a test if it were offered. Part 2 elicited willingness-to-pay values
of the tests using a payment scale followed by a bidding exercise, with the aim that these values
would provide a strength of preference not detectable using the binary approach.
Results
A large majority of participants chose to be tested for all cancers, with only colonoscopy (colorectal
cancer) demonstrating a risk gradient. In the willingness-to-pay exercise participants placed a lower
value on an X-ray (lung cancer) than the tests for colorectal or pancreatic cancer and X-ray was the
only test where risk was clearly related to the willingness-to-pay value.
Conclusion
Willingness-to-pay values did not enhance the binary responses in the way intended; participants
appeared to be motivated differently when responding to the two parts of the questionnaire. More
work is needed to understand how participants perceive risk in this context and how they respond to
questions about willingness-to-pay. Qualitative methods could provide useful insights.
Institute of Health Research
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