Why colorectal screening fails to achieve the uptake rates of breast and cervical cancer screening: a comparative qualitative study. Issue 6 (26th December 2019)

• Record Type: Journal Article
• Authors: Kotzur, Marie; McCowan, Colin; Macdonald, Sara; Wyke, Sally; Gatting, Lauren; Campbell, Christine; Weller, David; Crighton, Emilia; Steele, Robert J C; Robb, Kathryn A
• Is Part Of: BMJ quality & safety. Volume 29:Issue 6(2020)
• Page Start: 482
• Page End: 490
• Publication Date: 2019-12-26
• Subjects: qualitative research -- decision making -- human factors -- health policy; Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2019-009998
• Languages: English
• ISSNs: 2044-5415

Abstract

Abstract : Background: In Scotland, the uptake of clinic-based breast (72%) and cervical (77%) screening is higher than home-based colorectal screening (~60%). To inform new approaches to increase uptake of colorectal screening, we compared the perceptions of colorectal screening among women with different screening histories. Methods: We purposively sampled women with different screening histories to invite to semistructured interviews: (1) participated in all; (2) participated in breast and cervical but not colorectal ('colorectal-specific non-participants'); (3) participated in none. To identify the sample we linked the data for all women eligible for all three screening programmes in Glasgow, Scotland (aged 51–64 years; n=68 324). Interviews covered perceptions of cancer, screening and screening decisions. Framework method was used for analysis. Results: Of the 2924 women invited, 86 expressed an interest, and 59 were interviewed. The three groups' perceptions differed, with the colorectal-specific non-participants expressing that: (1) treatment for colorectal cancer is more severe than for breast or cervical cancer; (2) colorectal symptoms are easier to self-detect than breast or cervical symptoms; (3) they worried about completing the test incorrectly; and (4) the colorectal test could be more easily delayed or forgotten than breast or cervical screening. Conclusion: Our comparative approach suggested targets for future interventions to increase colorectal screening uptake including: (1) reducing fear of colorectal cancer treatments; (2) increasing awareness that screening is for the asymptomatic; (3) increasing confidence to self-complete the test; and (4) providing a suggested deadline and/or additional reminders.