Haemoccult compliance rates and reasons fornon-compliance

doi:10.1016/S0033-3506(84)80055-4

Public Health

Volume 98, Issue 1, January 1984, Pages 16-25

https://doi.org/10.1016/S0033-3506(84)80055-4 Get rights and content

Abstract

Bowel cancer is the second commonest malignancy in England and Wales. Mortality fromthis condition has remained constant over the last 30 years. At present there is the suggestion that screening will result in fewer deaths. The only practicable method is by use of the Haemoccult test, but compliance to this test is a major problem.

This study looked at compliance rates in two G.P. practices. Use of the kit and return of specimens was higher when the kit was sent through the post than when individuals were invited to collect it themselves. Women and individuals in the younger age group were more likely to comply.

When non-compliers were interviewed the most frequent reasons given for not usingthe test related to the unpleasant nature of faeces or the lack of time needed to complete the test. Many people also gave reasons which could be described as having little understanding of the principles or value of pre-symptomatic screening.

References (17)

FarrandsP. et al.
The Frome experiment — value of screening for colorectal cancer
Lancet
(1981)
O.P.C.S.
O.P.C.S.
O.P.C.S.
Gilbertsen
Earlier detection of colorectal cancers
Cancer
(1980)
HardcastleJ.D. et al.
Screening for symptomless colorectal cancer by testing for occult blood in general practice
Lancet
(1980)
ChapiusP. et al.
Report of a multidisciplinary research programme for colorectal cancer
Anticancer Research
(1981)
FarrandsP. et al.
The killer cancer few know about
General Practitioner
(1981)

There are more references available in the full text version of this article.

Cited by (34)

A multimedia patient education program on colorectal cancer screening increases knowledge and willingness to consider screening among Hispanic/Latino patients
2009, Patient Education and Counseling
To test a multimedia patient education program on colorectal cancer (CRC) screening that was designed specifically for the Hispanic/Latino community, and developed with input from community members.
A total of 270 Hispanic/Latino adults, age 50–80 years, participated in Spanish for all phases of this pretest–posttest design. Patients were randomly assigned to a version of the multimedia program that opened with either a positive or negative introductory appeal. Structured interviews assessed screening relevant knowledge (anatomy and key terms, screening options, and risk information), past screening behavior, willingness to consider screening options, intention to discuss CRC screening with the doctor, and reactions to the multimedia patient education program.
The multimedia program significantly increased knowledge of anatomy and key terms (e.g., polyp), primary screening options (FOBT, flexible sigmoidoscopy, colonoscopy), and risk information as well as willingness to consider screening (p < .001 for all). No significant differences emerged between positive and negative introductory appeals on these measures, intention to discuss CRC screening with their doctor, or rating the multimedia program.
Multimedia tools developed with community input that are designed to present important health messages using graphics and audio can reach Hispanic/Latino adults across literacy levels and ethnic backgrounds. Additional research is needed to determine effects on actual screening behavior.
Despite promising results for engaging a difficult-to-reach audience, the multimedia program should not be considered a stand-alone intervention or a substitute for communication with physicians. Rather, it is a priming mechanism intended to prepare patients for productive discussions of CRC screening.
Investigating Hispanic/Latino perceptions about colorectal cancer screening: A community-based approach to effective message design
2007, Patient Education and Counseling
The Hispanic/Latino population has been documented as having the lowest colorectal cancer (CRC) screening rates in the United States, putting this group at-risk for late-stage presentation of disease. We assessed knowledge, attitudes, and behavior regarding CRC screening to inform the development of messages that promote screening among Hispanic/Latino patients.
In-person structured interviews with Spanish-speaking adults age 50–80 at two clinics and a senior center in a Hispanic/Latino community (N = 234).
Most (67.1%) participants had no more than an eighth-grade education and 63.3% reported their reading ability as less than “very good.” Only 18.4% of participants correctly identified the colon on a diagram; 19.2% correctly described at least one aspect of a polyp. Less than half of the participants perceived themselves as at-risk for CRC, and less than one-third knew about any of the standard screening tests. After hearing descriptions of the screening tests, participants perceived stool cards as easier, safer, less painful, less embarrassing, and less scary than endoscopy (p < .001). Approximately two-thirds of unscreened patients said that screening had never been mentioned or suggested to them; about one-quarter said they did not get screened because they felt fine or were not worried. Over 96% of participants said they would get screened if a doctor suggested it.
Assessing knowledge, attitudes, beliefs, and experiences in the community of interest is a promising approach for developing effective targeted health messages.
Messages to increase CRC screening knowledge and behavior in the Hispanic/Latino community should address risk factors, identify relevant anatomy, explain polyps and their asymptomatic presentation, and clearly describe options.
Is the type of test used for mass colorectal cancer screening a determinant of compliance?. A cluster-randomized controlled trial comparing fecal occult blood testing with flexible sigmoidoscopy
2006, Cancer Detection and Prevention
Background: The efficacy of colorectal cancer screening has been proved, and three different screening tests are recommended by international guidelines: the faecal occult blood test, flexible sigmoidoscopy and colonoscopy. While the effectiveness of a screening program depends on the compliance obtained, the role of the type of test on compliance has not yet been sufficiently studied. Aims: To measure the effect of the type of screening test used, i.e. faecal occult blood test or flexible sigmoidoscopy, on the compliance to colorectal cancer screening programs. Subjects and methods: A cluster-randomized two-arm trial was conducted. We randomly assigned 20 GP's practices that had an average of 150 patients between 50 and 74 years old. Results: 1449 individuals were referred to faecal occult blood test and 1538 to flexible sigmoidoscopy. The faecal occult blood test obtained higher compliance: 17.2% (95%CI 12.5–25.7) versus 7.0% (95%CI 5.7–9.0). The socio-economic status was an effect modifier of the test type: the effect of the type of test was smaller in low socioeconomic classes. Conclusions: The type of screening test used for colorectal cancer is a determinant of participation. In a low compliance area, better compliance will result from offering the faecal occult blood test than from the flexible sigmoidoscopy.
Trying to improve the compliance to colorectal cancer screening: A complex study design for a complex planning question
2005, Contemporary Clinical Trials
The efficacy of faecal occult blood test as primary screening for colorectal cancer has been demonstrated. Screening programs, to be effective, should guarantee high compliance in the target population. The aim of this paper is to describe the design of three connected studies aimed at obtaining precise indications for planning a colorectal cancer screening program with high compliance. We designed a survey, with a randomised controlled trial nested within it, and a case–control study nested within that and defined by the results of the trial. The complex interconnection of studies reflects the aim to produce indications for an evidence-based planning of a public health program, which is itself, a complex phenomenon. The trial was designed to evaluate two different types of tests, Immunochemical and Guaiac, and two different providers, general practitioner and hospital, with a 2×2 factorial design. The randomization was performed at two different levels to minimize the loss of power: at the practice level for test type (cluster randomisation) and individual level for provider type.
The view from two sides: A qualitative study of community and medical perspectives on screening for colorectal cancer using FOBT
2004, Preventive Medicine
Background. Population-wide screening for people at average risk of colorectal cancer (CRC) by faecal occult blood test (FOBT) is under consideration in Australia.
Methods. Qualitative methods were used to examine the views of community members who did (n = 18) or did not (n = 12) participate in a pilot program of FOBT screening. In addition, views were obtained from general practitioners (GPs) and specialist gastroenterologists directly involved in the implementation of the program. Two focus group sessions were conducted with screening participants and interviews were conducted with nonparticipants, GPs and gastroenterologists.
Results. The findings suggest that CRC screening by FOBT distributed to households by mail was well accepted by the community and by the medical practitioners involved in its implementation. The trial had little negative effect on general practice. Both medical practitioners and consumers raised concerns about the efficacy of FOBT screening. Medical practitioners were also concerned about the potential burden mass screening could place on the public (government-funded) health care sector.
Conclusions. It would seem that CRC screening using FOBT will not enjoy unqualified support from the community or from medical practitioners involved in the continuum of screening. Information about the objectives of screening programs, in general, and the efficacy of FOBT screening in particular, needs to be provided to the community to ensure informed individual choice.
Factors associated with colorectal cancer screening among Chinese-Americans
2004, Preventive Medicine
Objective. To investigate factors associated with receipt of colorectal cancer (CRC) screening among urban senior Chinese-Americans.
Methods. Two hundred three men and women from three senior centers completed a questionnaire that included sections on demographics, fecal occult blood testing (FOBT) and sigmoidoscopy use, and potential barriers to screening.
Results. Receipt of a FOBT within the prior 12 months (37.9% of sample) was associated with fewer years of US residency, lower level of worries or fears of test results, and higher level of perceived susceptibility to CRC. Receipt of a flexible sigmoidoscopy within the past 5 years (22.2% of sample) was associated with higher levels of education, lower levels of worries or fears of test results, and higher level of perceived susceptibility of CRC.
Conclusions. Intervention programs may target these areas to facilitate CRC screening in Chinese-Americans so that national goals can be met for all Americans.

View all citing articles on Scopus

View full text

Haemoccult compliance rates and reasons fornon-compliance

Abstract

Lancet

Earlier detection of colorectal cancers

Cancer

Screening for symptomless colorectal cancer by testing for occult blood in general practice

Lancet

Report of a multidisciplinary research programme for colorectal cancer

Anticancer Research

The killer cancer few know about

General Practitioner