title: Improving participation in colorectal cancer screening: targets for action.
abstract: OBJECTIVE
  Our aim was to determine whether physician-related factors influenced patient participation in colorectal cancer (CRC) screening programs and to identify patient characteristics associated with lower participation in order to facilitate the development of targeted actions to improve participation.
  
  
  METHODS
  A retrospective cohort study was conducted in a French department during its first CRC screening campaign from June 2007 to May 2010. Data for 157,766 patients followed by 903 general practitioners (GPs) were analyzed. Patient participation was assessed using multilevel logistic modeling.
  
  
  RESULTS
  The overall participation rate was 30% (95% confidence interval [95% CI], 29.8-30.2) and varied across the 903 GPs from 0% to 75.5% (median, 30; interquartile range, 24-35). Inter-GP variance explained only 5.5% of the participation rate variance. Participation was significantly lower in males (odds ratio [OR], 0.79; 95% CI, 0.78-0.91), the youngest age group (55-59 years, OR, 0.61; 95% CI, 0.58-0.63), and patients living in socioeconomically deprived areas (OR, 0.82; 95% CI, 0.77-0.87).
  
  
  CONCLUSIONS
  Targeted actions to improve CRC screening participation should focus on patients younger than 60 years, males, and individuals living in deprived areas. Actions to enhance the influence of GPs on patient participation should be directed to the overall population of GPs.
authors.affiliation: Université Paris Est (UPEC), Faculté de Médecine, Department of General Practice, Creteil, F-94000, France. j.le.breton.com@gmail.com
authors.forename: Julien
authors.initials: J
authors.lastname: Le Breton
authors.forename: Neige
authors.initials: N
authors.lastname: Journy
authors.forename: Claude
authors.initials: C
authors.lastname: Attali
authors.forename: Philippe
authors.initials: P
authors.lastname: Le Corvoisier
authors.forename: Zahida
authors.initials: Z
authors.lastname: Brixi
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
mesh_terms: D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D005602:France; D058006:General Practice; D006291:Health Policy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012959:Socioeconomic Factors