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.
Highlights
As colorectal cancer (CRC) is the third most common cancer worldwide, screening is recommended to reduce both incidence of CRC and CRC-related mortality and morbidity [1,2]
The participants in this study described several motives for non-adherence to colonoscopy advice after a positive faecal immunochemical test (FIT) result in the Dutch CRC screening program
The intrinsic and extrinsic motives we found in this study were all mentioned in previous literature on the topic of non-follow up in CRC screening [19,20,25,26], and there were no main themes discussed in other recent qualitative studies that we did not find in this current investigation [19,20]
Summary
As colorectal cancer (CRC) is the third most common cancer worldwide, screening is recommended to reduce both incidence of CRC and CRC-related mortality and morbidity [1,2]. This goal is to be achieved by detecting CRC before it becomes symptomatic, or by detecting its relevant precursors, advanced adenomas (AA) [3]. After a positive FIT result, the advice is to follow up with a diagnostic colonoscopy. The risk associated with a positive FIT result ranges from 2.9–7.8% for CRC and 33.9–54% for AA [4]. As over half of FIT-positive (FITþ) individuals have advanced
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