Patient preferences for whole body MRI or conventional staging pathways in lung and colorectal cancer: a discrete choice experiment.

Miles, Anne and Taylor, S.A. and Evans, R.E.C. and Halligan, S. and Beare, S. and Bridgewater, J. and Goh, V. and Janes, S. and Navani, N. and Oliver, A. and Morton, A. and Rockall, A. and Clarke, C.S. and Morris, S. (2019) Patient preferences for whole body MRI or conventional staging pathways in lung and colorectal cancer: a discrete choice experiment. European Radiology 29 (7), pp. 3889-3900. ISSN 0938-7994.

Abstract

Objectives: To determine the importance placed by patients on attributes associated with whole body MRI (WB-MRI) and standard cancer staging pathways, and ascertain drivers of preference. Methods: Patients recruited to two multi-centre diagnostic accuracy trials comparing WB-MRI with standard staging pathways in lung and colorectal cancer were invited to complete a discrete choice experiment (DCE), choosing between a series of alternate pathways in which 6 attributes (accuracy, time to diagnosis, scan duration, whole body enclosure, radiation exposure, total scan number) were varied systematically. Data were analysed using a conditional logit regression model and marginal rates of substitution computed. The relative importance of each attribute and probabilities of choosing WB-MRI based pathways were estimated. Results: 138 patients (mean age 65, 61% male, lung n=72, colorectal n=66) participated (May 2015 to September 2016). Lung cancer patients valued, time to diagnosis most highly, followed by accuracy, radiation exposure, number of scans and time in the scanner. Colorectal cancer patients valued accuracy most highly, followed by time to diagnosis, radiation exposure and number of scans. Patients were willing wait 0.29 (lung), 0.45 (colorectal) weeks for a 1% increase in pathway accuracy. Patients preferred WB-MRI based pathways (probability 0.64 [lung], 0.66 [colorectal]) if they were equivalent in accuracy, total scan number, and time to diagnosis compared to a standard staging pathway. Conclusions: Staging pathways based on first line WB-MRI are preferred by the majority of patients if they at least match standard pathways for diagnostic accuracy, time to diagnosis and total scan number.

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