Reasons for non-participation in the Northern Ireland Bowel Cancer Screening Programme: a qualitative study

Bradley, Declan; Treanor, Charlene; McMullan, Colin; Owen, Tracy; Graham, Adele; Anderson, Diane

doi:10.1136/bmjopen-2015-008266

Cited by 29 publications

(31 citation statements)

References 23 publications

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“…Often the cases they discussed emphasised harrowing treatment, pain and death and did not discuss the benefits of early detection, despite being favourable towards the ethos of screening. Non-screeners certainly articulated the 'rather not know' position, a position that has been commonly reported in other studies (Bradley et al, 2015;Honein-AbouHaidar et al, 2016;Lipworth, Davey, Carter, Hooker & Hu, 2010) though some went further by stating that they would know if they had cancer because they were sure that they would experience symptoms, which echoes work done by others (Austin et al, 2009).…”

Section: Discussionmentioning

confidence: 59%

Perceived colorectal cancer candidacy and the role of candidacy in colorectal cancer screening

Bikker

Macdonald

Robb

et al. 2019

Health, Risk & Society

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Screening is a well-established tool to advance earlier cancer diagnosis. We used Davison's concept of 'candidacy' to explore how individuals draw on collectively constructed images of 'typical' colorectal cancer (CRC) sufferers, or 'candidates', in order to evaluate their own risk and to ascertain the impact of candidacy on screening participation in CRC. We interviewed 61 individuals who were invited to participate in the Scottish Bowel Screening Programme. Of these, 37 were screeners (17 men and 20 women) and 24 non-screeners (13 men and 11 women). To analyse these data we used a coding frame that drew on: symptoms, risk factors, and retrospective and prospective candidacy. Few participants could identify a definite bowel cancer candidate and notions of candidacy were largely predicated on luck in the sense that anyone could be a candidate for CRC and there was little evidence to support a linear relationship between feelings of risk and screening decisions. Often participants described screening as part of a wider portfolio of being healthy and referred to feeling obliged to look after themselves. Our study suggests that rather than candidates for bowel cancer, screeners viewed themselves as candidates for screening by which screening decisions pointed towards the acceptance and normalisation of the rhetoric of personal responsibility for health. These findings have related theoretical and practical implications; the moral structure that underpins the new public health can be witnessed practically in the narratives by which those who see themselves as candidates for screening embrace wider positive health practices.

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Section: Discussionmentioning

confidence: 59%

Perceived colorectal cancer candidacy and the role of candidacy in colorectal cancer screening

Bikker

Macdonald

Robb

et al. 2019

Health, Risk & Society

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“…12 20 28 These concerns were evident across most participants, however, comparisons of accounts between screeners and non-screeners showed that when there is a strong perceived need for reassurance about potential cancer presence, concerns about the invasiveness of the test and other practical barriers were more readily overcome. The concept of ‘perceived need for reassurance’, as described in our analysis, reflects an appraisal response to the activation of emotional reactions triggered by the screening invitation, specifically in relation to beliefs about personal risks and circumstances.…”

Section: Discussionmentioning

confidence: 99%

Concerns, perceived need and competing priorities: a qualitative exploration of decision-making and non-participation in a population-based flexible sigmoidoscopy screening programme to prevent colorectal cancer

et al. 2016

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ObjectiveOptimising uptake of colorectal cancer (CRC) screening is important to achieve projected health outcomes. Population-based screening by flexible sigmoidoscopy (FS) was introduced in England in 2013 (NHS Bowel scope screening). Little is known about reactions to the invitation to participate in FS screening, as offered within the context of the Bowel scope programme. We aimed to investigate responses to the screening invitation to inform understanding of decision-making, particularly in relation to non-participation in screening.DesignQualitative analysis of semistructured in-depth interviews and written accounts.Participants and settingPeople from 31 general practices in the North East and East of England invited to attend FS screening as part of NHS Bowel scope screening programme were sent invitations to take part in the study. We purposively sampled interviewees to ensure a range of accounts in terms of beliefs, screening attendance, sex and geographical location.Results20 screeners and 25 non-screeners were interviewed. Written responses describing reasons for, and circumstances surrounding, non-participation from a further 28 non-screeners were included in the analysis. Thematic analysis identified a range of reactions to the screening invitation, decision-making processes and barriers to participation. These include a perceived or actual lack of need; inability to attend; anxiety and fear about bowel preparation, procedures or hospital; inability or reluctance to self-administer an enema; beliefs about low susceptibility to bowel cancer or treatment and understanding of harm and benefits. The strength, rather than presence, of concerns about the test and perceived need for reassurance were important in the decision to participate for screeners and non-screeners. Decision-making occurs within the context of previous experiences and day-to-day life.ConclusionsUnderstanding the reasons for non-participation in FS screening can help inform strategies to improve uptake and may be transferable to other screening programmes.

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“…Many factors play a part in the reasons for non-participation in screening, including socioeconomic status, ethnicity, age, and gender [ 38 ]. The nature of the test procedure itself has also been reported as a reason for non-participation in CRC screening [ 39 , 40 ]: this is one of the reasons that many gFOBtbased programs are moving to FIT-based screening.…”

Section: How Should We Screen?mentioning

confidence: 99%

Colorectal Cancer Screening—Who, How, and When?

Bevan¹,

Rutter²

2018

Clin Endosc

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Colorectal cancer (CRC) is the third most common cancer worldwide. It is amenable to screening as it occurs in premalignant, latent, early, and curable stages. PubMed, Cochrane Database of Systematic Reviews, and national and international CRC screening guidelines were searched for CRC screening methods, populations, and timing. CRC screening can use direct or indirect tests, delivered opportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply to individuals 50–75 years of age. Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidence by detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult blood testing (gFOBt) was found to reduce CRC mortality by 13%–33%. Fecal immunochemical testing (FIT) has no RCT data comparing it to no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a 28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs, it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs are superior to opportunistic screening. However, no nation can offer organized population-wide colonoscopy screening. Thus, organized programs using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.

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Reasons for non-participation in the Northern Ireland Bowel Cancer Screening Programme: a qualitative study

Cited by 29 publications

References 23 publications

Perceived colorectal cancer candidacy and the role of candidacy in colorectal cancer screening

Perceived colorectal cancer candidacy and the role of candidacy in colorectal cancer screening

Concerns, perceived need and competing priorities: a qualitative exploration of decision-making and non-participation in a population-based flexible sigmoidoscopy screening programme to prevent colorectal cancer

Colorectal Cancer Screening—Who, How, and When?

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