24433682
BACKGROUND	The UK lags behind many European countries in terms of cancer survival .
BACKGROUND	Initiatives to address this disparity have focused on barriers to presentation , symptom recognition , and referral for specialist investigation .
BACKGROUND	Selection of patients for further investigation has come under particular scrutiny , although preferences for referral thresholds in the UK population have not been studied .
BACKGROUND	We investigated preferences for diagnostic testing for colorectal , lung , and pancreatic cancers in primary-care attendees .
METHODS	In a vignette-based study , researchers recruited individuals aged at least 40 years attending 26 general practices in three areas of England between Dec 6 , 2011 , and Aug 1 , 2012 .
METHODS	Participants completed up to three of 12 vignettes ( four for each of lung , pancreatic , and colorectal cancers ) , which were randomly assigned .
METHODS	The vignettes outlined a set of symptoms , the risk that these symptoms might indicate cancer ( 1 % , 2 % , 5 % , or 10 % ) , the relevant testing process , probable treatment , possible alternative diagnoses , and prognosis if cancer were identified .
METHODS	Participants were asked whether they would opt for diagnostic testing on the basis of the information in the vignette .
RESULTS	3469 participants completed 6930 vignettes .
RESULTS	3052 individuals ( 88 % ) opted for investigation in their first vignette .
RESULTS	We recorded no strong evidence that participants were more likely to opt for investigation with a 1 % increase in risk of cancer ( odds ratio [ OR ] 102 , 95 % CI 099-106 ; p = 0189 ) , although the association between risk and opting for investigation was strong when colorectal cancer was analysed alone ( 108 , 103-113 ; p = 00001 ) .
RESULTS	In multivariable analysis , age had an effect in all three cancer models : participants aged 60-69 years were significantly more likely to opt for investigation than were those aged 40-59 years , and those aged 70 years or older were less likely .
RESULTS	Other variables associated with increased likelihood of opting for investigation were shorter travel times to testing centre ( colorectal and lung cancers ) , a family history of cancer ( colorectal and lung cancers ) , and higher household income ( colorectal and pancreatic cancers ) .
CONCLUSIONS	Participants in our sample expressed a clear preference for diagnostic testing at all risk levels , and individuals want to be tested at risk levels well below those stipulated by UK guidelines .
CONCLUSIONS	This willingness should be considered during design of cancer pathways , particularly in primary care .
CONCLUSIONS	The public engagement with our study should encourage general practitioners to involve patients in referral decision making .
BACKGROUND	The National Institute for Health Research Programme Grants for Applied Research programme .

