What Factors Influence Non-Participation Most in Colorectal Cancer Screening? A Discrete Choice Experiment

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Background and Objective
Non-participation in colorectal cancer (CRC) screening needs to be decreased to achieve its full potential as a public health strategy. To facilitate successful implementation of CRC screening towards unscreened individuals, this study aimed to quantify the impact of screening and individual characteristics on non-participation in CRC screening.

An online discrete choice experiment partly based on qualitative research was used among 406 representatives of the Dutch general population aged 55–75 years. In the discrete choice experiment, respondents were offered a series of choices between CRC screening scenarios that differed on five characteristics: effectiveness of the faecal immunochemical screening test, risk of a false-negative outcome, test frequency, waiting time for faecal immunochemical screening test results and waiting time for a colonoscopy follow-up test. The discrete choice experiment data were analysed in a systematic manner using random-utility-maximisation choice processes with scale and/or preference heterogeneity (based on 15 individual characteristics) and/or random intercepts.

Screening characteristics proved to influence non-participation in CRC screening (21.7–28.0% non-participation rate), but an individual’s characteristics had an even higher impact on CRC screening non-participation (8.4–75.5% non-participation rate); particularly the individual’s attitude towards CRC screening followed by whether the individual had participated in a cancer screening programme before, the decision style of the individual and the educational level of the individual. Our findings provided a high degree of confidence in the internal–external validity.

This study showed that although screening characteristics proved to influence non-participation in CRC screening, a respondent’s characteristics had a much higher impact on CRC screening non-participation. Policy makers and physicians can use our study insights to improve and tailor their communication plans regarding (CRC) screening for unscreened individuals.
Original languageEnglish
Pages (from-to)269–281
Number of pages13
JournalThe patient: Patient-Centered Outcomes Research
Issue number2
Early online date5 Nov 2020
Publication statusPublished - 5 Dec 2020

Bibliographical note

This study was funded by The Netherlands Organisation for Scientifc Research (NWO-Talent-Scheme-Veni-Grant No. 451-15-039). The funder had no role in the study design, the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.

Research programs

  • EMC NIHES-02-67-01


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