TY - JOUR
T1 - Reasons for No Colonoscopy After an Unfavorable Screening Result in Dutch Colorectal Cancer Screening
T2 - A Nationwide Questionnaire
AU - Bertels, Lucinda S.
AU - van Asselt, Kristel M.
AU - van Weert, Henk C. P. M.
AU - Dekker, Evelien
AU - Knottnerus, Bart J.
N1 - Funding Information: Funding support: This study was funded by the Dutch Cancer Society (KWF), grant number UVA 2015-8083. This study was performed independently from the funder with respect to study design; data collection, analysis, and interpretation; writing of the manuscript; and decision to submit the manuscript for publication. Funding Information: support: This study was funded by the Dutch Cancer Society (KWF), grant number UVA 2015-8083. This study was performed independently from the funder with respect to study design; data collection, analysis, and interpretation; writing of the manuscript; and decision to submit the manuscript for publication. Acknowledgments: We acknowledge contributions to the development of the questionnaire by Kirsten Douma, Peter Lucassen, Danielle Timmermans, Mechteld Visser, and Mirjam Fransen and contributions to the data analysis by Wim Busschers. We acknowledge the Dutch Screening organization for distribu-tion of the questionnaire, in particular the Foundation of Population Screening East, Foundation of Population Screening Mid-West, Foundation of Population Screening North, Foundation of Population Screening South, and Foundation of Population Screening South-West. In addition, we acknowledge the participants in the Dutch CRC screening program who were willing to cooperate with us in a previous interview study to determine potential barriers to adherence to colo-noscopy advice, as well as participants who helped us in the pilot testing of the questionnaire. Publisher Copyright: © 2022, Annals of Family Medicine, Inc. All rights reserved.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - PURPOSE We aimed to assess participant-reported factors associated with non–follow-up with colonoscopy in colorectal cancer (CRC) screening. METHODS In May 2019, we distributed a nationwide cross-sectional questionnaire (n = 4,009) to participants in the Dutch CRC screening program who received a positive fecal immunochemical test (FIT). Among respondents who reported no colonoscopy, we assessed the presence of a contraindication, and those without were compared with those who reported colonoscopy by logistic regression analysis. RESULTS Of 2,225 respondents (56% response rate), 730 (33%) reported no colonos-copy. A contraindication was reported by 55% (n = 404). Decisional difficulties (odds ratio [OR] = 0.29; 95% CI, 0.18-0.47), lacking the opportunity to discuss the FIT outcome (OR = 0.45; 95% CI, 0.28-0.72), and a low estimated risk of CRC (OR = 0.45; 95% CI, 0.26-0.76) were negatively associated with follow-up. Knowledge items negatively associated with follow-up included having an alternative explanation for the positive FIT (OR = 0.3; 95% CI, 0.21-0.43), having trust in the ability to self-detect CRC (OR = 0.42; 95% CI, 0.27-0.65), and thinking that polyp removal is ineffective (OR = 0.59; 95% CI, 0.43-0.82). The belief that the family physician would support colonoscopy showed the strongest positive association with follow-up (OR = 2.84; 95% CI, 2.01-4.02) CONCLUSIONS Because decisional difficulties and certain convictions regarding CRC and screening are associated with non–follow-up, personalized screening counseling might be an intervention worth exploring as a means of improving follow-up in the Dutch CRC screening program. Involving family physicians might also prove beneficial.
AB - PURPOSE We aimed to assess participant-reported factors associated with non–follow-up with colonoscopy in colorectal cancer (CRC) screening. METHODS In May 2019, we distributed a nationwide cross-sectional questionnaire (n = 4,009) to participants in the Dutch CRC screening program who received a positive fecal immunochemical test (FIT). Among respondents who reported no colonoscopy, we assessed the presence of a contraindication, and those without were compared with those who reported colonoscopy by logistic regression analysis. RESULTS Of 2,225 respondents (56% response rate), 730 (33%) reported no colonos-copy. A contraindication was reported by 55% (n = 404). Decisional difficulties (odds ratio [OR] = 0.29; 95% CI, 0.18-0.47), lacking the opportunity to discuss the FIT outcome (OR = 0.45; 95% CI, 0.28-0.72), and a low estimated risk of CRC (OR = 0.45; 95% CI, 0.26-0.76) were negatively associated with follow-up. Knowledge items negatively associated with follow-up included having an alternative explanation for the positive FIT (OR = 0.3; 95% CI, 0.21-0.43), having trust in the ability to self-detect CRC (OR = 0.42; 95% CI, 0.27-0.65), and thinking that polyp removal is ineffective (OR = 0.59; 95% CI, 0.43-0.82). The belief that the family physician would support colonoscopy showed the strongest positive association with follow-up (OR = 2.84; 95% CI, 2.01-4.02) CONCLUSIONS Because decisional difficulties and certain convictions regarding CRC and screening are associated with non–follow-up, personalized screening counseling might be an intervention worth exploring as a means of improving follow-up in the Dutch CRC screening program. Involving family physicians might also prove beneficial.
KW - Dutch
KW - colorectal neoplasms
KW - counseling
KW - follow-up studies
KW - mass screening
KW - physicians, family
KW - surveys and questionnaires
UR - http://www.scopus.com/inward/record.url?scp=85142605247&partnerID=8YFLogxK
U2 - https://doi.org/10.1370/afm.2871
DO - https://doi.org/10.1370/afm.2871
M3 - Article
C2 - 36443069
SN - 1544-1709
VL - 20
SP - 526
EP - 534
JO - Annals of family medicine
JF - Annals of family medicine
IS - 6
ER -