Patient Preferences for Investigating Cancer-Related Symptoms in Australian General Practice: A Discrete Choice Experiment.

Abstract

Striking the right balance between early cancer diagnosis and the risk of excessive testing for low-risk symptoms is of paramount importance. Patient-centred care must also consider patient preferences for testing. To investigate diagnostic testing preferences of the Australian public for symptoms associated with oesophagogastric (OG), bowel, or lung cancer. One of three discrete choice experiments (DCEs) related to either OG, bowel, or lung cancer were administered to a nationally representative sample of Australians aged 40 and above. Each DCE comprised three scenarios with symptom positive predictive values (PPVs) for undiagnosed cancer ranging from 1% to 3%. The numerical risk was concealed from participants. DCE attributes encompassed the testing strategy, GP familiarity, test and result waiting times, travel duration, and test cost. Preferences were estimated using conditional and mixed logit models. A total of 3013 individuals participated in one of three DCEs: OG (n=1004), Bowel (n=1006), and Lung (n=1003). Preferences were chiefly driven by waiting time, test cost followed by the test type. There was preference for more invasive tests. When confronted with symptoms carrying an extremely low risk (symptom PPV of 1% or less), participants were more inclined to abstain from testing. Access-related factors, particularly waiting times and testing costs, emerged as the most pivotal elements influencing preferences, underscoring the substantial impact of these systemic factors on patient choices regarding investigations.