Advancing Colorectal Cancer Detection With Blood-Based Tests: Qualitative Study and Discrete Choice Experiment to Elicit Population Preferences

Background: Colorectal cancer (CRC) is the second most deadly form of cancer, inducing an estimated 1.9 million incidencecases and 0.9 million deaths worldwide in 2020. Despite the availability of screening tests, their uptake remains suboptimal.However, blood-based tests that look for signs of cancer-specific markers in the body are increasingly available as an alternativefor more invasive tests for cancer. Compared with existing tests, the benefits of blood-based tests for CRC include not needingpretest preparation, stool handling, and dietary or medication restrictions. Objective: This study aims to explore the population's preferences for CRC screening tests, with a focus on blood-based tests,and investigate the factors influencing test uptake. Methods: We used a mixed methods approach, combining semistructured interviews and a discrete choice experiment (DCE)survey. Interviews were analyzed using thematic analysis to identify salient attributes for CRC screening tests. These attributesinformed the design of the DCE survey. The DCE data were analyzed using mixed logit and mixed-mixed multinomial logitmodels. Results: Qualitative findings from 30 participants revealed that participants preferred blood-based tests due to their perceivedlow risk, minimal pain, and ease of sample collection. However, concerns about the test's lower accuracy were also expressed.The DCE survey was completed by 1189 participants. In the mixed logit model, participants demonstrated a stronger preferencefor blood-based tests over a 2-day stool-based test. The mixed-mixed multinomial logit model identified 2 classes, strong supportersand weak supporters, for CRC screening. Weak supporters, but not strong supporters, had a higher preference for blood-basedtests. Women, ethnic Chinese, and people aged 40 to 60 years were more likely to be weak supporters. Both models highlightedthe high influence of cost and test sensitivity on participants'preferences. Transitioning from a 2-day stool-based test to ablood-based test, assuming a national screening program at a base price of Singapore $5 (US $3.75), was estimated to have thepotential to increase the relative uptake by 5.9% (95% CI 3.6%-8.2%). Conclusions: These findings contribute to our understanding of CRC screening preferences and provide insights into the factorsdriving test uptake. This study highlights the perceived advantages of blood-based tests and identifies areas of concern regardingtheir accuracy. Further research is needed to determine the actual increase in uptake rate when blood-based tests are made available