Grant Number:	1R01CA317672-01 Interpret this number
Primary Investigator:	Gunn, Christine
Organization:	Dartmouth College
Project Title:	Investigating Information Preferences, Risk Perceptions, and Tradeoffs in Multi-Cancer Early Detection Decisions: a Randomized Vignette Trial
Fiscal Year:	2026

PROJECT SUMMARY Cancer remains the second leading cause of death in the United States. While cancer screening has contributed to improvements in cancer morbidity and mortality, more than half of all cancers diagnosed have no associated screening tests. Multi-cancer early detection (MCED) tests are an emerging technology with the potential to transform cancer screening: These tests use a blood sample to predict the presence of up to 50 types of cancer, and they are becoming increasingly available for use in clinical practice. While there is optimism for MCED tests, they have modest positive predictive values, often do not identify the specific site of cancer, and require complex and costly diagnostic testing to determine or rule out the presence of cancer. MCED testing decisions that minimize harms and maximize benefits require decision supports that address the informational needs and preferences of decision-makers. The overall objective of this research is to determine what MCED test information and detail people need to make high-quality, informed decisions about using MCED tests to screen for cancer. Aim 1 will evaluate how the content and level of detail about MCED test performance, diagnostic workup, and associated costs influence decision quality and intentions to use MCED tests. We will conduct a randomized vignette trial with an established probability sample (N=3,000) representative of the United States 40-74 year-old population with no prior cancer history. Participants will be randomized to one of eight vignettes representing all potential combinations of informational factors (test performance, diagnostic workup, cost) and levels of detail (high vs. low). Informational factors will be presented across three phases with survey assessments after each phase. Aim 2 will assess how participant characteristics affect MCED testing decisions to support targeted intervention strategies. This aim will explore heterogeneity of vignette effects across prior screening participation, cancer risk perception, language and numeracy. Aim 3 will characterize how MCED test decisions influence patients’ perceptions of existing cancer screenings. In-depth qualitative interviews (n=48) will explore how people use the vignette information provided in MCED decision-making, and how they plan to integrate MCED testing with existing disease-specific screening modalities. This research will generate the data needed to create decision aids that prepare patients and clinicians for the increasing availability of MCED tests and promote their ethical implementation in clinical practice.





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