Development of a scale for evaluating screening tests for cancer : attributes patients emphasize (escape)

Abstract

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] The public's overenthusiasm for cancer screening tests has the potential to subject many individuals to harms such as overdetection and false positives. Thus, it is of the utmost importance that we understand what drives patient preferences for screening in the first place. Then, once these preferences are defined and understood, the information regarding the various positive and negative attributes of options -- as well as the likelihoods associated with these attributes for an individual -- and any other features of the decision could be tailored to the individual. This dissertation proposes and validates a new measure that identifies what features individuals find important when choosing a screening test and how they vary relative to others. Herein, a set of factors regarding screening test attributes was created, and a 5-factor structure was both explored and confirmed. The scale is shown to be reliable and to have convergent and discriminant validity. Further, the structure was not found to replicate in a more diverse population. Instead the more diverse sample has a 6-factor structure. Finally, this individual difference scale was compared with a discrete choice experiment and a threshold technique, finding all of these methods vary and none of them are capable of predicting screening choices.