Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Scand J Prim Health Care. 2020 Dec;38(4):487-498. doi: 10.1080/02813432.2020.1844391. Epub 2020 Nov 13.
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.
To investigate FIT-positive individuals' motives for non-adherence to colonoscopy advice in the Dutch CRC screening program.
Non-adherent FIT-positive participants of the Dutch CRC screening program.
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.
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.
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.
在结直肠癌（CRC）筛查项目中，粪便免疫化学检测（FIT）阳性的参与者患结直肠癌和高级腺瘤的风险很高。因此，建议他们进行结肠镜检查。然而，超过 10%的筛查阳性者不遵守这一建议。
调查荷兰 CRC 筛查项目中 FIT 阳性者不遵守结肠镜检查建议的原因。
荷兰 CRC 筛查项目中不接受结肠镜检查的 FIT 阳性参与者。
我们对 17 名在 FIT 阳性后 6 个月内未进行结肠镜检查的参与者进行了半结构化深入访谈。访谈是面对面进行的，数据采用开放式编码和不断比较进行主题分析。
所有参与者不遵守结肠镜检查建议的原因都是多方面的。对更个性化护理的偏好描述如下主题：对筛查计划设计的反感、对个性化护理的期望、与非个性化护理相关的情绪以及希望在那里讨论除结肠镜检查以外的其他选择的咨询。此外，还有内在动机：对 CRC 风险的认知较低（所有参与者都有这种认知）、对结肠镜检查的反感和恐惧、不信任、对癌症治疗的抵触态度以及癌症宿命论。外在动机是：有其他健康问题或优先事项、实际障碍、全科医生（GP）的建议和经济原因。
个性化的筛查咨询可能有助于改善参与者对筛查计划的体验，以及他们对 CRC 和 CRC 筛查的了解。未来的研究应探讨个性化筛查咨询是否也有可能提高依从率。关键点：在两步式结直肠癌（CRC）筛查程序中，FIT 阳性的参与者患 CRC 和高级腺瘤的风险很高。在全球所有 CRC 计划中，由于不利筛查结果，不遵守筛查后建议的情况都有发生，因此许多参与者未接受结肠镜检查以明确评估 CRC 的存在。很少有定性研究来研究为什么个人参与了筛查的第一步，但没有参与第二步。我们发现了对更个性化护理的偏好，这在以前关于这个主题的文献中没有报道过。此外，内在因素，如低风险认知和不信任，以及外在因素，如存在其他健康问题和 GP 建议，也可能在不遵守建议中发挥作用。以筛查咨询会议形式的以患者为中心的方法可能对这组 CRC 筛查参与者有益。
