PT  - JOURNAL ARTICLE
AU  - Lucinda S. Bertels
AU  - Kristel M. van Asselt
AU  - Henk C. P. M. van Weert
AU  - Evelien Dekker
AU  - Bart J. Knottnerus
TI  - Reasons for No Colonoscopy After an Unfavorable Screening Result in Dutch Colorectal Cancer Screening: A Nationwide Questionnaire
AID  - 10.1370/afm.2871
DP  - 2022 Nov 01
TA  - The Annals of Family Medicine
PG  - 526--534
VI  - 20
IP  - 6
4099  - http://www.annfammed.org/content/20/6/526.short
4100  - http://www.annfammed.org/content/20/6/526.full
SO  - Ann Fam Med2022 Nov 01; 20
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 colonoscopy. 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.