title: Acceptance of flexible sigmoidoscopy as a screening examination for colorectal cancer in an outpatient clinic.
abstract: OBJECTIVE
  Flexible sigmoidoscopy (FS) is a feasible examination technique and a suitable tool for population-based screening, but very little is known about determinants of endoscopic screening participation. The aim of this study was to determine the acceptance rate and the factors influencing the decision of participating in a screening program for patients in an outpatient clinic.
  
  
  METHODS
  In this prospective study, a colorectal cancer screening by FS was offered to 631 patients older than 40 years. Three strategies were available, (1) to have the endoscopy on the same day, (2) to make an appointment for another day, or (3) to take time to think about if they wanted the procedure. The reasons for refusal of the FS were documented.
  
  
  RESULTS
  419 of the 631 (66.4%) patients had no interest to take part in the screening program during their outpatient visit. Two hundred twelve (33.6%) patients were primarily interested on FS, but only 110 of them were finally examined. In total, 102 patients did not make an appointment for FS or did not appear for the endoscopy. The participation rate was therefore 17.4% (110/631) of all patients. Of the patients who agreed to receive an on-site examination, 78.3% were examined compared to 18.8% of patients who fixed the appointment for another day or after taking time to reflect upon the FS procedure. More male than female patients accepted the FS screening. Recommended colonoscopy was finally performed in 76%. Thirty-three polyps were found during the screening program of which 18 were larger than 0.5 cm. No CRC was detected. All patients agreed to repeat the FS every 5 years.
  
  
  CONCLUSIONS
  This study demonstrates that a screening examination will be most likely performed if it is done as an on-site examination. In contrast, the participation rate is low if the patient has to make an appointment by himself. Acceptance of FS screening is also dependent on the patient's gender and family history of cancer. Additional strategies are needed to further improve participation.
authors.affiliation: Department of Internal Medicine I, University Regensburg, 93042 Regensburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Gölder
authors.forename: W
authors.initials: W
authors.lastname: Vogt
authors.forename: H
authors.initials: H
authors.lastname: Lichti
authors.forename: H C
authors.initials: HC
authors.lastname: Rath
authors.forename: A
authors.initials: A
authors.lastname: Kullmann
authors.forename: J
authors.initials: J
authors.lastname: Schölmerich
authors.forename: F
authors.initials: F
authors.lastname: Kullmann
mesh_terms: D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012812:Sigmoidoscopy / Q000523:psychology / Q000706:statistics & numerical data*