Declining the offer of flexible sigmoidoscopy screening for bowel cancer:: a qualitative investigation of the decision-making process

• Published in: Social science & medicine (1982) 2001-09, Vol.53 (5), p.679-691
• Main Authors: McCaffery, Kirsten, Borril, Jo, Williamson, Sara, Taylor, Tamara, Sutton, Stephen, Atkin, Wendy, Wardle, Jane
• Format: Article
• Language: English
• Subjects: Attitudes; Barriers; Biological and medical sciences; Bowel cancer; Bowel cancer screening; Bowel cancer screening Flexible sigmoidoscopy Barriers Non-participation; Bowel disease; Cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - prevention & control; Decision Making; England; Female; Flexible sigmoidoscopy; Gastroenterology. Liver. Pancreas. Abdomen; Health Knowledge, Attitudes, Practice; Humans; Illness; Interviews as Topic; Male; Mass Screening - methods; Mass Screening - psychology; Medical Decision Making; Medical sciences; Medical screening; Medical sociology; Medical treatment; Medicine; Middle Aged; Middle Aged Adults; Middle aged people; Motivation; Non-participation; Patient Acceptance of Health Care - psychology; Qualitative research; Screening; Sigmoidoscopy; Sigmoidoscopy - psychology; Sigmoidoscopy - statistics & numerical data; Social sciences; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tests; Treatment Refusal - psychology; Tumors
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(00)00375-0

Qualitative methods were used to investigate decision-making among a group of older adults who declined the offer of flexible sigmoidoscopy screening for bowel cancer. Interviews were conducted with 60 people (30 men and 30 women) who either had not responded to the screening letter or who responded saying that they were not interested in participating. The findings suggest that low perceived susceptibility to bowel cancer, in terms of current health status, family history or absence of bowel symptoms, was an important factor in the decision to decline screening. Procedural barriers such as embarrassment, pain/discomfort and perceived unpleasantness of the test were reported as relatively minor, although the test was considered more physically intrusive than other screening tests. Avoidant attitudes emerged as an important theme and were reported by a third of respondents. Distinct patterns of decision-making were also observed and three groups emerged from accounts: (i) forgetting or avoiding making a decision about the test (ii) a confident rejection of the test based on a few salient factors, and (iii) a more careful consideration of the test focusing on issues of susceptibility. The findings are discussed in the context of models of health behaviour and bowel cancer screening participation research.