Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study.
OBJECTIVE
Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD.


METHODS
Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39-78 years old with CKD stages 3-5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand. Thematic analysis was used to analyze the transcripts.


RESULTS
Five themes were identified: invisibility of cancer (unspoken stigma, ambiguity of risk, and absence of symptomatic prompting); prioritizing kidney disease (preserving the chance of transplantation, over-riding attention to kidney disease, protecting graft survival, and showing loyalty to the donor); preventing the crisis of cancer (evading severe consequences and cognizant of susceptibility); cognitive resistance (reluctance to perform a repulsive procedure, intensifying disease burden threshold, anxiety of a positive test, and accepting the inevitable); and pragmatic accessibility (negligible financial effect, convenience, and protecting anonymity).


CONCLUSIONS
Patients with CKD understand the potential health benefits of bowel cancer screening, but they are primarily committed to their kidney health. Their decisions regarding screening revolve around their present health needs, priorities, and concerns. Explicit consideration of the potential practical and psychosocial burdens that bowel cancer screening may impose on patients in addition to kidney disease and current treatment is suggested to minimize decisional conflict and improve patient satisfaction and health care outcomes in CKD.
Sydney School of Public Health, University of Sydney, Sydney, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
Laura J
LJ
James
Sydney School of Public Health, University of Sydney, Sydney, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
Germaine
G
Wong
Sydney School of Public Health, University of Sydney, Sydney, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
Jonathan C
JC
Craig
Sydney School of Public Health, University of Sydney, Sydney, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
Angela
A
Ju
Sydney School of Public Health, University of Sydney, Sydney, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
Narelle
N
Williams
Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia; and.
Wai H
WH
Lim
Department of Nephrology, Christchurch Hospital, Christchurch, New Zealand.
Nicholas
N
Cross
Sydney School of Public Health, University of Sydney, Sydney, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
Allison
A
Tong
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000523:psychology; D003657:Decision Making; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000523:psychology* / Q000628:therapy
Anxiety; Attention; Attitude; Australia; Cognition; Early Detection of Cancer; Graft Survival; Humans; Neoplasms; New Zealand; Patient Satisfaction; Renal Insufficiency, Chronic; Risk; Transplant Recipients; bowel cancer screening; chronic kidney disease; interview; kidney; kidney transplant recipient; qualitative research; renal dialysis; shared-decision making