Can streamlined multicriteria decision analysis be used to implement shared decision making for colorectal cancer screening?

James G. Dolan, Emily Boohaker, Jeroan Allison, Thomas F. Imperiale

Research output: Contribution to journalArticle

9 Scopus citations


Background. Current US colorectal cancer screening guidelines that call for shared decision making regarding the choice among several recommended screening options are difficult to implement. Multicriteria decision analysis (MCDA) is an established method well suited for supporting shared decision making. Our study goal was to determine whether a streamlined form of MCDA using rank-order- based judgments can accurately assess patients' colorectal cancer screening priorities. Methods. We converted priorities for 4 decision criteria and 3 subcriteria regarding colorectal cancer screening obtained from 484 average-risk patients using the analytic hierarchy process (AHP) in a prior study into rank-order-based priorities using rank order centroids. We compared the 2 sets of priorities using Spearman rank correlation and nonparametric Bland-Altman limits of agreement analysis. We assessed the differential impact of using the rank-order-based versus the AHP-based priorities on the results of a full MCDA comparing 3 currently recommended colorectal cancer screening strategies. Generalizability of the results was assessed using Monte Carlo simulation. Results. Correlations between the 2 sets of priorities for the 7 criteria ranged from0.55 to 0.92. The proportions of differences between rank-order-based and AHP-based priorities that weremore than 60.15 ranged from 1% to 16%. Differences in the full MCDA results were minimal, and the relative rankings of the 3 screening options were identical more than 88% of the time. The Monte Carlo simulation results were similar. Conclusions. Rank-order-based MCDA could be a simple, practical way to guide individual decisions and assess population decision priorities regarding colorectal cancer screening strategies. Additional research is warranted to further explore the use of these methods for promoting shared decision making.

Original languageEnglish (US)
Pages (from-to)746-755
Number of pages10
JournalMedical Decision Making
Issue number6
StatePublished - Aug 2014


  • Analytic hierarchy process
  • Colorectal cancer screening
  • Multicriteria decision analysis
  • Shared decision making

ASJC Scopus subject areas

  • Health Policy

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