Lucinda Bertels1,2, Peter Lucassen3, Kristel van Asselt1, Evelien Dekker4, Henk van Weert1, Bart Knottnerus1,5. 1. Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. 3. Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. 4. Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 5. Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands.
Abstract
SETTING: Participants with a positive faecal immunochemical test (FIT) in screening programs for colorectal cancer (CRC) have a high risk for colorectal cancer and advanced adenomas. They are therefore recommended follow-up by colonoscopy. However, more than ten percent of positively screened persons do not adhere to this advice. OBJECTIVE: To investigate FIT-positive individuals' motives for non-adherence to colonoscopy advice in the Dutch CRC screening program. SUBJECTS: Non-adherent FIT-positive participants of the Dutch CRC screening program. DESIGN: We conducted semi structured in-depth interviews with 17 persons who did not undergo colonoscopy within 6 months after a positive FIT. Interviews were undertaken face-to-face and data were analysed thematically with open coding and constant comparison. RESULTS: All participants had multifactorial motives for non-adherence. A preference for more personalised care was described with the following themes: aversion against the design of the screening program, expectations of personalised care, emotions associated with experiences of impersonal care and a desire for counselling where options other than colonoscopy could be discussed. Furthermore, intrinsic motives were: having a perception of low risk for CRC (described by all participants), aversion and fear of colonoscopy, distrust, reluctant attitude to the treatment of cancer and cancer fatalism. Extrinsic motives were: having other health issues or priorities, practical barriers, advice from a general practitioner (GP) and financial reasons. CONCLUSION: Personalised screening counselling might have helped to improve the interviewees' experiences with the screening program as well as their knowledge on CRC and CRC screening. Future studies should explore whether personalised screening counselling also has potential to increase adherence rates. Key points Participants with a positive FIT in two-step colorectal cancer (CRC) screening programs are at high risk for colorectal cancer and advanced adenomas. Non-adherence after an unfavourable screening result happens in all CRC programs worldwide with the consequence that many of the participants do not undergo colonoscopy for the definitive assessment of the presence of colorectal cancer. Little qualitative research has been done to study the reasons why individuals participate in the first step of the screening but not in the second step. We found a preference for more personalised care, which was not reported in previous literature on this subject. Furthermore, intrinsic factors, such as a low risk perception and distrust, and extrinsic factors, such as the presence of other health issues and GP advice, may also play a role in non-adherence. A person-centred approach in the form of a screening counselling session may be beneficial for this group of CRC screening participants.
SETTING:Participants with a positive faecal immunochemical test (FIT) in screening programs for colorectal cancer (CRC) have a high risk for colorectal cancer and advanced adenomas. They are therefore recommended follow-up by colonoscopy. However, more than ten percent of positively screened persons do not adhere to this advice. OBJECTIVE: To investigate FIT-positive individuals' motives for non-adherence to colonoscopy advice in the Dutch CRC screening program. SUBJECTS: Non-adherent FIT-positive participants of the Dutch CRC screening program. DESIGN: We conducted semi structured in-depth interviews with 17 persons who did not undergo colonoscopy within 6 months after a positive FIT. Interviews were undertaken face-to-face and data were analysed thematically with open coding and constant comparison. RESULTS: All participants had multifactorial motives for non-adherence. A preference for more personalised care was described with the following themes: aversion against the design of the screening program, expectations of personalised care, emotions associated with experiences of impersonal care and a desire for counselling where options other than colonoscopy could be discussed. Furthermore, intrinsic motives were: having a perception of low risk for CRC (described by all participants), aversion and fear of colonoscopy, distrust, reluctant attitude to the treatment of cancer and cancer fatalism. Extrinsic motives were: having other health issues or priorities, practical barriers, advice from a general practitioner (GP) and financial reasons. CONCLUSION: Personalised screening counselling might have helped to improve the interviewees' experiences with the screening program as well as their knowledge on CRC and CRC screening. Future studies should explore whether personalised screening counselling also has potential to increase adherence rates. Key points Participants with a positive FIT in two-step colorectal cancer (CRC) screening programs are at high risk for colorectal cancer and advanced adenomas. Non-adherence after an unfavourable screening result happens in all CRC programs worldwide with the consequence that many of the participants do not undergo colonoscopy for the definitive assessment of the presence of colorectal cancer. Little qualitative research has been done to study the reasons why individuals participate in the first step of the screening but not in the second step. We found a preference for more personalised care, which was not reported in previous literature on this subject. Furthermore, intrinsic factors, such as a low risk perception and distrust, and extrinsic factors, such as the presence of other health issues and GP advice, may also play a role in non-adherence. A person-centred approach in the form of a screening counselling session may be beneficial for this group of CRC screening participants.
Authors: Usha Menon; Rhonda Belue; Stéphanie Wahab; Kathryn Rugen; Anita Y Kinney; Peter Maramaldi; Debra Wujcik; Laura A Szalacha Journal: Ann Behav Med Date: 2011-12
Authors: Adriano Correia; Linda Rabeneck; Nancy N Baxter; Lawrence F Paszat; Rinku Sutradhar; Lingsong Yun; Jill Tinmouth Journal: Prev Med Date: 2015-04-18 Impact factor: 4.018
Authors: Anke J Woudstra; Daniëlle R M Timmermans; Ellen Uiters; Evelien Dekker; Ellen M A Smets; Mirjam P Fransen Journal: Health Expect Date: 2017-12-20 Impact factor: 3.377
Authors: Ashley C Mog; Peter S Liang; Lucas M Donovan; George G Sayre; Aasma Shaukat; Folasade P May; Thomas J Glorioso; Michelle A Jorgenson; Gordon Blake Wood; Candice Mueller; Jason A Dominitz Journal: Clin Transl Gastroenterol Date: 2022-02-01 Impact factor: 4.396