Reasons for Participation and Nonparticipation in Colorectal Cancer Screening: A Randomized Trial of Colonoscopy and CT Colonography

Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
The American Journal of Gastroenterology (Impact Factor: 10.76). 12/2012; 107(12):1777-83. DOI: 10.1038/ajg.2012.140
Source: PubMed


We compared reported reasons for participation and nonparticipation in colorectal cancer (CRC) screening between colonoscopy and computed tomographic (CT) colonography in a randomized controlled trial.

We randomly invited 8,844 people for screening by colonoscopy or CT colonography. On a questionnaire, invitees indicated reasons for participation or nonparticipation and indicated the most decisive reason.

The most frequently cited reasons to accept screening were early detection of precursor lesions and CRC, and contribution to science. The most frequently cited reasons to decline were the unpleasantness of the examination, the inconvenience of the preparation, a lack of symptoms, and "no time/too much effort." Among colonoscopy nonparticipants, elderly invitees cited inconvenience less often, and absence of symptoms more often, than did the group overall. The reason reported most frequently as the most decisive reason not to participate was the unpleasantness of the examination among colonoscopy nonparticipants, and "no time/too much effort" and lack of symptoms among CT colonography nonparticipants.

In light of these results, future screening programs could tailor the information provided to invitees.

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    • "Screening colonoscopy provides a good opportunity for further evaluation of the TMI, given its importance in health maintenance contrasted with its presumed morbidity from the viewpoint of patients. In a recent large study, the most commonly voiced reason to not participate in colonoscopy screening was the unpleasantness of the examination [20]. Colonoscopy requires patients to undergo purging of colonic contents, usually done the day before the procedure, when patients are also put on Table 1 – Multiattribute health classification and survey items: Testing Morbidities Index Attribute Description of level Pain/discomfort preparing for the test 1. "
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    ABSTRACT: The Testing Morbidities Index (TMI) was developed to measure the effects of any diagnostic or screening procedure on health-related quality of life (HRQOL); it includes seven domains incorporating mental and physical aspects before, during, and after testing. To add to prior work on the validity of the TMI classification, responsiveness of a summated scale version was evaluated in 71 colonoscopy patients. Further data on construct validity were also obtained. Patients enrolled in the study when scheduling colonoscopy days to weeks beforehand. The baseline survey included the EuroQol five-dimensional (EQ-5D) questionnaire with five levels in each attribute (EQ-5D-5L questionnaire) and its visual analogue scale (VAS) assessment (EQ-VAS), the Short Form 12 version 2 (SF-12v2) component summary scores and six-dimensional health state short-form (derived from the short-form 12v2 health survey [SF-6D] utilities), and an original construct-specific VAS (CS-VAS) for usual HRQOL using utility scale anchors. The TMI's highest possible summated score (all best levels) served as its baseline. Survey data were generally obtained by telephone interview. A postprocedure survey was given to patients after colonoscopy and interviews conducted as soon as possible after the day of the procedure. The postprocedure survey included the SF-12v2/SF-6D, EQ-5D questionnaire instruments, TMI items, and a CS-VAS incorporating the overall HRQOL effects of colonoscopy. Standardized response means showed greatest responsiveness by the TMI (-1.52) followed by the CS-VAS instruments (-0.42). The EQ-5D-5L questionnaire, the EQ-VAS, and the SF-12 component summaries were unresponsive, and the SF-6D was minimally responsive (-0.05). Correlation of the post-CS-VAS with the TMI was substantial (r = -0.52), suggesting TMI construct validity. Moderate to strong correlation of the baseline CS-VAS with standard indexes was observed (r = 0.54-0.81). The TMI appears responsive and exhibits further evidence of construct validity.
    Value in Health 09/2013; 16(6):1046-53. DOI:10.1016/j.jval.2013.07.008 · 3.28 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate the level of informed decision making in a randomized controlled trial comparing colonoscopy and CT-colonography for colorectal cancer screening. METHODS: 8844 citizens aged 50-75 were randomly invited to colonoscopy (n=5924) or CT-colonography (n=2920) screening. All invitees received an information leaflet. Screenees received a questionnaire within 4 weeks before the planned examination, non-screenees 4 weeks after the invitation. A decision was categorized as informed when characterized by sufficient decision-relevant knowledge and consistent with personal attitudes toward participation in screening. RESULTS: Knowledge and attitude items were completed by 1032/1276 colonoscopy screenees (81%), by 698/4648 colonoscopy non-screenees (15%), by 824/982 CT-colonography screenees (84%) and by 192/1938 CT-colonography non-screenees (10%). 1027 colonoscopy screenees (>99%) and 815 CT-colonography screenees (99%) had adequate knowledge; 915 (89%) and 742 (90%) had a positive attitude. 675 non-screenees invited to colonoscopy (97%) and 182 invited to CT-colonography (95%) had adequate knowledge; 344 (49%) and 94 (49%) expressed a negative attitude. CONCLUSION: A large majority of screenees made an informed decision on participation. Almost half of responding non-screenees, made an uninformed decision, suggesting additional barriers to participation. PRACTICE IMPLICATIONS: Efforts to understand the additional barriers will create opportunities to facilitate informed participation to colorectal cancer screening.
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