When the primary and secondary outcomes of clinical studies yield ambiguous or conflicting recommendations, preference or valuation studies may help to overcome the decision problem.
It is well-established that screening participation varies by ethnic group (Moser and Patnick, 2009; CDC, 2012), so further investigation of recommendation preferences in non-white groups should be a priority for future research.
Future research could build on these results with more nuanced questions on information and recommendation preferences that could address public understanding of the constraints placed on healthcare providers in the extent of recommendation they can provide given the imperative of basing advice on the best available evidence.
Although differences in screening uptake by gender and marital status have been found previously (Seeff et al, 2004; van Jaarsveld et al, 2006; von Wagner et al, 2011), it is not clear how recommendation preferences might interact with approaches to screening communication to affect participation.
Previous research has shown SES differences in awareness of the purpose of screening or its effects (James et al, 2008; Orbell et al, 2008; Beeken et al, 2011), but the present results, using social grade as a marker of SES, showed no evidence that this translates into differences in recommendation preferences.
Contrary to our prediction, social grade was not associated with recommendation preference.
Respondents (n=103) who did not answer the question on recommendation preference were excluded from the analyses, leaving a sample of 1964 (see Table 1a).
Finally, we used an occupational indicator of SES, and this might be a reason for the lack of association between SES and recommendation preference.
After descriptive analyses, we used ordinal logistic regression to explore associations between level of screening recommendation preference and (i) trust in the NHS, (ii) desire for information on risks and benefits, and (iii) social grade.
Other questionnaires will enable collecting data on quality of life (SF-36), living conditions, food storage and dietary habits, behavior and restrictions, knowledge of nutritional recommendations, food preferences, etc.
In the example, the PMI is therefore [50- -134 /90- -134 ], representing the concordance between the preference scores for the physician treatment recommendations and preference scores for the participants' preferred treatment.
