Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer

Abstract

Understanding the reasons for nonparticipation in cancer screening may give clues about how to improve compliance. However, limited cooperation has hampered research on nonparticipant profiles. We took advantage of Sweden's comprehensive demographic and health care registers to investigate characteristics of all participants and nonparticipants in a pilot program for colorectal cancer screening with sigmoidoscopy. A population-based sample of 1986 Swedish residents 59-61 years old was invited. Registers provided information on each individual's gender, country of birth, marital status, education, income, hospital contacts, place of residence, distance to screening center and cancer within the family. Odds ratios (ORs) with 95% confidence intervals (CIs), modeled with multivariable logistic regression, estimated the independent associations between each background factor and the propensity for nonparticipation after control for the effects of other factors. All statistical tests were 2-sided. Being male (OR 5 1.27, 95% CI 5 1.03-1.57, relative to female), unmarried or divorced (OR 5 1.69, 95% CI 5 1.23-2.30 and OR 5 1.49, 95% CI 5 1.14-1.95, respectively, relative to married) and having an income in the lowest tertile (OR 5 1.68, 95% CI 5 1.27-2.23, relative to highest tertile) was associated with increased nonparticipation. Living in the countryside or in small communities and having a documented family history of colorectal cancer was associated with better participation. Distance to the screening center did not significantly affect participation, nor did recent hospital care consumption or immigrant status. To increase compliance, invitations must appeal to men, unmarried or divorced people and people with low socioeconomic status. ' 2007 Wiley-Liss, Inc.Key words: mass screening; colorectal neoplasms; sigmoidoscopy; patient participation; registers To be effective on a population level, screening programs have to be widely accepted. To minimize nonparticipation, it is important to understand the reasons for nonattendance and to identify groups that would benefit from extra recruitment efforts. Further, understanding of selection forces is necessary for valid interpretation of the effects of screening.Investigators of nonparticipation, whether in screening, public health campaigns or scientific investigations typically have to resort to interviews or questionnaires. As the motivation among nonparticipants generally is low, such studies are characterized by low response rates and questionable data quality. For example, in a recently published Norwegian study concerning a colorectal cancer screening program, only 11% of the nonparticipants responded to a follow-up questionnaire. 1 To our knowledge, no comprehensive model explaining nonparticipation in cancer screening has yet gained widespread acceptance. The scarcity of unbiased background information among nonparticipants may have contributed to this lack of a firm conceptual basis for the understanding of underlying mechanisms.We took advantage of 8 national ...

Decentralized colonoscopic surveillance with high patient compliance prevents hereditary and familial colorectal cancer

“…In our study, the patient compliance was very high (90 %), compared to participation rates reported (10–39 %) from screening programs in the general population [17, 18]. We have not found information on compliance in previous reports on surveillance of FCRC or HCRC.…”

A 9-Year Follow-up Study of Participants and Nonparticipants in Sigmoidoscopy Screening: Importance of Self-Selection

“…However, in our study of risk indicators for nonparticipation (13), neither the hospitalization rate in the 5-year period preceding invitation nor previous cancer history differed significantly between nonparticipants and participants. Moreover, removing invitees with a current cancer (diagnosed within 5 years before the invitation) from our analyses did not substantially change the overall picture.…”

“…Another possibility is that the self-selection is determined by the socioeconomic status of the invitees, known to be linked to morbidity and mortality (17)(18)(19). Our invitees in the lowest tertile of income, according to the Register of Income and Wealth (20), were significantly less prone to participate compared with the invitees in the highest tertile (13). Earlier studies have indicated that socioeconomically underprivileged people are less motivated to participate in screening (21)(22)(23)(24).…”

“…In a separate article, we have evaluated the effect of some sociodemographic characteristics, hospital contacts, distance to the screening center, and cancer in the family on nonparticipation (13). Having male gender, being unmarried or divorced, and having a low income were associated with low participation, whereas a family history of colorectal cancer was linked with increased participation (13).…”

Are gender-associated differences in quality of life in colorectal cancer patients disease-specific?

“…In contrast to previous findings [7,8], a recent study from Sweden [9] found lower participation in sigmoidoscopy screening programs for men compared to women (OR 1.27). The authors relate this to the lower interest of men in preventive health care and their poorer knowledge about health issues.…”