A systematic review of patient preference elicitation methods in the treatment of colorectal cancer A. Currie*, A. Askari*, S. Nachiappan*, N. Sevdalis†‡, O. Faiz*† and R. Kennedy*† *St Mark’s Hospital and Academic Institute, Harrow, Middlesex, UK, †Department of Surgery and Cancer, Imperial College London, London, UK and ‡Centre for Patient Safety and Service Quality, Imperial College London, London, UK Received 14 April 2014; revised 19 June 2014; accepted 27 June 2014; Accepted Article online 22 August 2014 Abstract Aim This systematic review aimed to assess the use of patient preference in colorectal cancer treatment. Elicit- ing patient preference is important for shared decision- making in colorectal cancer treatment. The introduction of newer treatments, which balance quality of life and overall survival, makes this an important future focus. Method A systematic search strategy of MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Data- base for Systematic Reviews was undertaken to obtain relevant articles. Information regarding the type of patients included, preference instruments, study set- tings, outcomes and limitations was extracted. Results The eight articles comprising this review each described an empirical study using a validated instru- ment to define patient preference for an aspect of colo- rectal cancer treatment. The evidence suggests that patients are prepared to trade significant reductions in life expectancy to avoid certain complications of colo- rectal surgery, particularly stoma formation. In the adju- vant setting, patients are prepared to risk significant treatment side effects to gain small potential increases in life expectancy and chance of survival. Where neoadju- vant or adjuvant treatment risks worsening function, however, patients generally forgo any potential increase in survival to improve bowel function and therefore quality of life. The only predictors of preference were tertiary education and previous cancer treatment. Conclusion Most patients judge a moderate survival benefit to be sufficient to make adjuvant therapy for colorectal cancer worthwhile, but they are willing to trade a potential reduction in life expectancy and sur- vival to avoid certain unwanted surgical sequelae. Keywords Patient preference, decision-making, color- ectal cancer, surgery, oncology What does this study add to the literature? This review summarizes the patient preference litera- ture across the whole colorectal cancer treatment path- way and finds that quality of life drives patients’ surgical treatment decisions. Introduction Decision-making is fundamental for the successful man- agement of malignancy. In colorectal cancer, matters such as mortality, morbidity, quality of life (QoL), stoma formation and cure rates from surgical and adju- vant interventions are relevant to patients during the consultation with the surgeon [1,2]. The decisions patients need to take during the colorectal cancer treat- ment pathway are complex and require appraisal of risk and benefit, the balance depending on the patients’ cir- cumstances. Several studies have demonstrated that sur- geons, oncologists and patients frequently place different emphasis on the end-points of treatment including the side effects [3,4], and that patients’ views are often not adequately considered when treatment is discussed at the multidisciplinary cancer meeting [5,6]. The increasing emphasis on patient autonomy and shared decision-making between patients and their phy- sicians has resulted in a more explicit assessment of patients’ preferences and opinions regarding treatment [7]. Preferences can be elicited by means of various methods, such as standard gamble, a time trade-off method and health economic techniques, e.g. discrete choice experiments [8]. All these methods present patients with descriptive and probabilistic information about the benefits and side effects associated with two or more treatment options. Determining the patient’s willingness to accept side effects of a treatment or forgo Correspondence to: Professor Robin Kennedy, Consultant Colorectal Surgeon, St Mark’s Hospital, Watford Rd, Harrow, Middlesex HA1 3UJ, UK. E-mail: robin.kennedy@nhs.net Colorectal Disease ª 2014 The Association of Coloproctology of Great Britain and Ireland. 17, 17–25 17 Systematic review doi:10.1111/codi.12754