The effect of information on prostate cancer screening decision process: a discrete choice experiment.

BACKGROUND: Prostate cancer screening is controversial because of uncertainty about its benefits and risks. The aim of this survey was to reveal preferences of men concerning prostate cancer screening and to test the effect of an informative video on these preferences. METHODS: A stated preferences questionnaire was sent by e-mail to men aged 50-75 with no history of prostate cancer. Half of them were randomly assigned to view an informative video. A discrete choice model was established to reveal men's preferences for six prostate cancer screening characteristics: mortality by prostate cancer, number of false positive and false negative results, number of overdiagnosis, out-of-pocket costs and recommended frequency. RESULTS: A population-based sample composed by 1024 men filled in the entire questionnaire. Each attribute gave the expected sign except for overdiagnosis. The video seemed to increase the intention to abstain from prostate cancer screening. CONCLUSIONS: The participants attached greater importance to a decrease in the number of false negatives and a reduction in prostate cancer mortality than to other risks such as the number of false positives and overdiagnosis. Further research is needed to help men make an informed choice regarding screening.

[Social inequalities in health from observational studies to intervention: can the patient navigator reduce social inequalities in cancer patients?]. / Inégalités sociales, de santé du constat à l'action - Intérêt de la mise en place d'un accompagnement personnalisé pour la réduction des inégalités sociales en cancérologie.

The impact of social factors on healthcare inequality is well-recognized in many industrialized countries and involves a wide range of pathological conditions (cardiovascular disease, cancer, etc.). In general, the poorest indicators of health are observed in socially disadvantaged populations. Beyond this observation is the question of actions taken to prevent the formation of social inequality in healthcare. The purpose of this work was to evaluate the potential contribution of an intervention tool called the "patient navigator", used in English-speaking countries and to determine its feasibility in France.

[Principle, strengths and weaknesses of discrete choice modelling for eliciting public preferences for health care]. / Principe, intérêts et limites de la méthode des choix discrets pour la révélation des préférences en santé.

Patients play an increasingly active role in the medical decision making process. Hence, methods for eliciting public preferences have become essential tools for enlightening the choices of health authorities. Discrete choice modelling is the most recently applied technique in the field of health. This article deals with the principle, the strengths and the weaknesses of this method. Often used in English-speaking countries, the discrete choice method has several advantages over other elicitation methods since it allows estimation of marginal utilities. Compliance rates are also higher and more information is provided. Considering these qualities, further research should be undertaken on discrete choice modelling in France.

[Advantage of immunochemical fecal occult blood test in screening for colorectal cancer]. / Apport des tests immunologiques de recherche de sang occulte dans les selles pour le dépistage du cancer colorectal.

Colorectal cancer screening is a high public health priority in all industrialized countries. However, the low sensitivity of the common guaiac screening test (Haemoccult II) makes practitioners and public health deciders reluctant to set up national screening program. In recent years, immunochemical tests based on the use of a specific antibody have been found to be more sensitive than the Haemoccult II test. However, for screening purposes, any gain in sensitivity is of interest only if specificity and positive predictive value are satisfactory. As instance, rehydration of the Haemoccult II test prior to lecture can increase sensitivity, but the associated decrease in specificity and positivity predictive value and the high positivity rate render its value in mass screening debatable. Moreover, extra costs, if existing, must be acceptable for the society. Until recently, immunochemical tests costs made it unaffordable in our societies. The arrival of automated reading is likely to remove this obstacle. Moreover it offers the opportunity of positivity cut-off choice. A recent study was conducted in Cotentin (France) to assess the performance of an immunochemical test with an automated reading technique (Magstream 1000) for different haemoglobin content cut-off points. As previous American, Japanese, Chinese and Italian studies, this study suggests that the use of immunochemical tests could lead a substantial gain, in screening sensitivity. Moreover by choosing a higher haemoglobin content as cut-off point (50 ng/ml instead of usual cut-off at 20 ng/ml), a gain in sensitivity can be obtained with a satisfactory specificity (97%) and positivity rate (3%). Considering the increasing number of publications, the use of an immunochemical test with an automated reading technique could improve the prospects for mass-screening for colorectal cancer, since it offers a promising alternative to guaiac tests.