title: What influences the decision to participate in colorectal cancer screening with faecal occult blood testing and sigmoidoscopy?
abstract: BACKGROUND
  Uptake is an important determinant of the effectiveness of population-based screening. Uptake of colorectal cancer (CRC) screening generally remains sub-optimal.
  
  
  OBJECTIVE
  To determine factors influencing the decision whether to participate or not among individuals invited for faecal occult blood test (FOBT) or flexible sigmoidoscopy (FS) screening.
  
  
  METHODS
  A questionnaire was sent to a stratified random sample of individuals aged 50-74, previously invited for a randomised CRC screening trial offering FOBT or FS, and a reference group from the same population not previously invited (screening naïve group). The questionnaire assessed reasons for (non)-participation, individuals' characteristics associated with participation, knowledge, attitudes and level of informed choice.
  
  
  RESULTS
  The response rate was 75% (n=341/452) for CRC screening participants, 21% (n=676/3212) for non-participants and 38% (n=192/500) for screening-naïve individuals. The main reasons for FOBT and FS participation were acquiring certainty about CRC presence and possible early CRC detection. Anticipated regret and positive attitudes towards CRC screening were strong predictors of actual participation and intention to participate in a next round. The main reason for non-participation in FOBT screening was lack of abdominal complaints. Non-participation in FS screening was additionally influenced by worries about burden. Eighty-one percent of participants and 12% of non-participants made an informed choice on participation.
  
  
  CONCLUSIONS
  Only 12% of non-participants made an informed choice not to participate. These results imply that governments and/or organizations offering screening should focus on adequately informing and educating target populations about the harms and benefits of CRC screening. This may impact uptake of CRC screening.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. l.vandam.1@erasmusmc.nl
authors.forename: L
authors.initials: L
authors.lastname: van Dam
authors.forename: I J
authors.initials: IJ
authors.lastname: Korfage
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: L
authors.initials: L
authors.lastname: Hol
authors.forename: A H C
authors.initials: AH
authors.lastname: van Roon
authors.forename: J C I Y
authors.initials: JC
authors.lastname: Reijerink
authors.forename: M
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: M E
authors.initials: ME
authors.lastname: van Leerdam
mesh_terms: D000368:Aged; D002755:Choice Behavior; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000523:psychology; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D009780:Occult Blood; D012812:Sigmoidoscopy / Q000379:methods*; D011795:Surveys and Questionnaires