Background In the Dutch colorectal cancer (CRC) screening programme, individuals receive a faecal immunochemical test (FIT) to do at home. After a positive FIT result, a follow-up colonoscopy is recommended to identify CRC or advanced adenomas (AA). GPs may influence their patients’ decisions on adherence to follow-up by colonoscopy. Aim To explore GPs’ perspectives on the CRC screening programme and their potential influence on FIT-positive patients to follow up with the recommended colonoscopy. Design & setting Semi-structured interviews among GPs in Amsterdam, the Netherlands. Method GPs were approached using purposive sampling. Analysis was performed on 11 interviews using open coding and constant comparison. Results All interviewed GPs would recommend FIT-positive patients without obvious contraindications to adhere to a follow-up colonoscopy. If patients were likely to be distressed by a positive FIT result, most GPs described using reassurance strategies emphasising a low cancer probability. Most GPs stressed the probability of false-positive FIT results. Some described taking a positive screening result in CRC screening less seriously than one in breast cancer screening. Most GPs underestimated CRC and AA probabilities after a positive FIT result. When told the actual probabilities, some stated that this knowledge might change the way they would inform patients. Conclusion These results imply that some of the interviewed GPs have too low a perception of the risk associated with a positive FIT result, which might influence their patients’ decision-making. Simply informing GPs about the actual rates of CRC and AA found in the screening programme might improve this risk perception.

Primary Health Care, Family Practice, Colorectal Neoplasms, Early Detection of Cancer, Colorectal Cancer Screening, Qualitative Research,
BJGP open
Erasmus School of Health Policy & Management (ESHPM)

Bertels, L.S, van der Heijden, S., Hoogsteyns, M., Dekker, E., van Asselt, K.M., van Weert, H.C.P.M., & Knottnerus, B.J. (2019). GPs’ perspectives on colorectal cancer screening and their potential influence on FIT-positive patients: an exploratory qualitative study from a Dutch context. BJGP open, 3(1). doi:10.3399/bjgpopen18X101631