TY - JOUR
T1 - Motives for non-adherence to colonoscopy advice after a positive colorectal cancer screening test result
T2 - a qualitative study
AU - Bertels, Lucinda
AU - Lucassen, P
AU - van Asselt, KM
AU - Dekker, E
AU - van Weert, HCPM
AU - Knottnerus, BJ
PY - 2020/11/13
Y1 - 2020/11/13
N2 - 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-toface 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.
AB - 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-toface 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.
UR - https://www.tandfonline.com/doi/full/10.1080/02813432.2020.1844391
U2 - 10.1080/02813432.2020.1844391
DO - 10.1080/02813432.2020.1844391
M3 - Article
C2 - 33185121
SN - 0281-3432
VL - 38
SP - 487
EP - 498
JO - Scandinavian Journal of Primary Health Care
JF - Scandinavian Journal of Primary Health Care
IS - 4
ER -