Why do some participants in colorectal cancer screening choose not to undergo colonoscopy following a positive test result? A qualitative study

Figures & data

Figure 1. Numbers from a report on the first ten months of the CRC screening, in Region Zealand, one of the five health regions of Denmark [7]. The author of this article however identified the numbers in the boxes marked in grey.

Table 1. Description of interview participants in random order.

Gender	Age	Education	Career	Residence	Multimorbidity	Interview
M	54	Public school and vocational training	Forest worker	The countryside	Yes	By telephone
M	64	Vocational education	Mechanic	The countryside	Yes	By e-mail
M	75	Vocational education	Carpenter	City	No	By telephone
M	67	Bachelor	Pedagogue	City	No	By telephone
F	51	Public school	Cleaning, early retirement	City	Yes	By telephone
F	73	Public school	Statistical work	The countryside	No	At our offices
F	70	Vocational education	Hairdresser, Nursing home employee	Village	Yes	Home of informant
M	61	Ten years of public school	Corporate chief	City	Yes	By telephone
M	70	Public school	Handyman	The countryside	No	By telephone
F	70	Public school	Odd jobs, early retirement	City	Yes	Home of informant
M	76	Ten years of public school	Public servant, manager of taxation	Village	Yes	By telephone
F	54	Grammar school	Odd jobs, early retirement	City	Yes	Home of informant
F	70	Bachelor	Teacher	Village	No	By telephone

Table 2. Nine categories and 42 reasons why our participants declined colonoscopy following a positive iFOBT.

Found categories and underlying reasons	F1	F2	F3	M4	M5	F6	F7	M8	M9	M10	M11	F12	M13
Practical barriers
Lack of offer of local anaesthesia						X
Can not or will not undergo the cleansing alone		X
Do not want treatment if polyps are detected, so thinks procedure is futile						X				X		X
Distance to travel										X
Discomfort
Have heard about the colonoscopy being uncomfortable	X		X
Have experienced the colonoscopy as being physically uncomfortable		X		X
Have experienced the colonoscopy as being psychologically uncomfortable				X
Have read about the colonoscopy being uncomfortable						X			X
Have an idea that the colonoscopy is uncomfortable									X				X
Dislike of MOVIPREP			X
Do not want a big ‘hose’ up their behind													X
Fear of discomfort following the sedative													X
Personal integrity
Does not like the appearance of his/her “behind”						X
The colonoscopy is an overstepping of his/her bounds												X
It is unnatural to put something inside something that is meant to be an ‘exit’												X
Multimorbidity
Psychiatric		X	X
Somatic		X	X		X								X
Feeling healthy
No reason to provoke something, by touching something healthy	X
Feeling healthy	X		X				X		X
Convinced that there is no colon cancer						X
Don't want to be medicalised							X
Don't want to go around with a constant worry						X
No reason to touch anything healthy									X
Always having had a healthy pelvic area	X
Not having the energy
Disease of family members has taken up a big part of life	X
Own disease has taken up a big part of life		X			X			X
Lack of energy		X			X
Belief that cancer is not present
Probability of it being due to haemorrhoids		X	X		X	X		X		X		X	X
Probability of it being due to a scratch			X				X		X			X
Lack of family history										X
Information of other causes of bleeding from doctor	X			X	X
Lack of physical symptoms			X			X
Have other pre-existing colon-condition, that can cause bleeding				X		X
Complications
Do not want a perforation of the bowel		X
Lack of trust in the doctors’ abilities to perform the examination without mistakes		X						X
Trauma from previous experience with the healthcare system								X
Worried about complications, mentioned in the information leaflet			X					X
Have heard about people dying from the colonoscopy													X
Distrust in the accuracy of the iFOBT
Have heard of others who have received false-positive answers			X
Distrust in the presence of blood, because it is not visible		X	X
Doctor has said that only a small fraction of people receiving a positive answer are sick					X
Don't want to participate anymore, since they have never found anything before		X

Sundhedstyrelsen, [The Danish Health Authorities]. Dansk, Tarmkraeftscreeningsdatabase Årsrapport. 2014 [The danish colorectal cancer screening database Annual Report 2014]. 2014 [cited Jan 2017]. Available at https://www.sundhed.dk/content/cms/45/61245_dts%C3%A5rsrapport-2014_8-1-16_final_inklbilag.pdf.

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