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Waiting for diagnostic colonoscopy: a qualitative exploration of screening participants’ experiences in a FIT-based colorectal cancer screening program

Authors Kirkegaard P, Edwards A, Larsen MB, Andersen B

Received 24 October 2017

Accepted for publication 23 March 2018

Published 17 May 2018 Volume 2018:12 Pages 845—852

DOI https://doi.org/10.2147/PPA.S154959

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen


Pia Kirkegaard,1 Adrian Edwards,1,2 Mette Bach Larsen,1 Berit Andersen1,3

1Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark; 2Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK; 3Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

Background: Participants in population-based screening for colorectal cancer (CRC) may experience increased anxiety immediately after a positive screening test, but research in this area is limited. The objective of this study was to explore how screening participants experience a positive test result and cope with the pre-diagnostic waiting period in a CRC screening program.
Materials and methods: Screening participants with a positive fecal immunochemical test (FIT) result were identified in the Danish national CRC program before they attended diagnostic colonoscopy. Sixteen screening participants were selected for an interview in their own homes, using a semi-structured interview guide. Transcribed data were analyzed thematically.
Results: The most prominent themes were symptom appraisal and communication strategies. Most participants attributed the positive FIT result showing blood in the stool to pre-existing non-malignant conditions but a few were very worried about the FIT result and the outcome of the colonoscopy. Communication strategies included discussions with family or friends about the positive FIT result and the upcoming colonoscopy, or containing information until the colonoscopy had provided the definitive diagnostic result. There was no apparent need for communication with health care professionals during the pre-diagnostic waiting period.
Conclusion: The pre-diagnostic waiting period between positive FIT result and colonoscopy in a population-based screening program may cause worry for some participants, potentially to require support, but most people consider it unconcerning. Screening providers should communicate to all screening participants in written form that negative emotional responses may occur after a positive screening result. This is particularly important in screening programs using self-sample kits without the presence of a health care professional to reassure the few participants who may experience significant anxiety.

Keywords: health services research, population-based cancer screening, colorectal cancer, fecal testing, coping, qualitative research

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