10.1111/(ISSN)1369-7625 HEX Health Expectations Health Expect 1369-6513 1369-7625 10.1111/hex.13175 HEX13175 ORIGINAL RESEARCH PAPER ORIGINAL RESEARCH PAPERS Acceptability and potential impact on uptake of using different risk stratification approaches to determine eligibility for screening: A population‐based survey USHER‐SMITH et al. Usher‐Smith Juliet A. MB, BChir, PhD https://orcid.org/0000-0002-8501-2531 jau20@medschl.cam.ac.uk * 1 Harvey‐Kelly Laragh L. W. BA (Hons) 2 Rossi Sabrina H. MBChB, MPhil 3 Harrison Hannah DPhil 1 Griffin Simon J. MBBS, DM 1 Stewart Grant D. MBChB, PhD 4 The Primary Care Unit Department of Public Health and Primary Care University of Cambridge Cambridge UK University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital Cambridge UK Department of Oncology University of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical Campus Cambridge UK Department of Surgery University of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical Campus Cambridge UK Correspondence Juliet A. Usher‐Smith, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK. Email: jau20@medschl.cam.ac.uk 02 12 2020 04 2021 24 2 10.1111/hex.v24.2 341 351 15 10 2020 05 06 2020 15 11 2020 Copyright © 2021 John Wiley & Sons Ltd © 2020 The Authors. Health Expectations published by John Wiley & Sons Ltd. 2020 © 2020 The Authors. Health Expectations published by John Wiley & Sons Ltd. http://creativecommons.org/licenses/by/4.0/ This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Abstract Background

Using risk stratification approaches to determine eligibility has the potential to improve efficiency of screening.

 Objectives

To compare the public acceptability and potential impact on uptake of using different approaches to determine eligibility for screening.

 Design

An online population‐based survey of 668 adults in the UK aged 45‐79 including a series of scenarios in the context of a potential kidney cancer screening programme in which eligibility was determined by age, sex, age and sex combined, a simple risk score (age, sex, body mass index, smoking status), a complex risk score additionally incorporating family history and lifestyle, or a genetic risk score.

 Outcome measures

We used multi‐level ordinal logistic regression to compare acceptability and potential uptake within individuals and multivariable ordinal logistic regression differences between individuals.

 Results

Using sex, age and sex, or the simple risk score were less acceptable than age (P < .0001). All approaches were less acceptable to women than men. Over 70% were comfortable waiting until they were older if the complex risk score or genetics indicated a low risk. If told they were high risk, 85% would be more likely to take up screening. Being told they were low risk had no overall influence on uptake.

 Conclusions

Varying the starting age of screening based on estimated risk from models incorporating phenotypic or genetic risk factors would be acceptable to most individuals and may increase uptake.

 Patient or Public Contribution

Two members of the public contributed to the development of the survey and have commented on this paper.

 acceptability public attitudes risk stratification screening Cancer Research UK http://dx.doi.org/10.13039/501100000289 C55650/A21464 Major Centre Award A25117 Kidney Cancer UK Research Trainees Coordinating Centre http://dx.doi.org/10.13039/501100000659 RM‐SR‐2017‐09‐009 Renal Cancer Research Fund