• Lucinda S Bertels, Kristel M van Asselt, van WeertHenk C P MHCPMAmsterdam UMC, University of Amsterdam, Department of General Practice, Cancer Center Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands., Evelien Dekker, and Bart J Knottnerus.
• Amsterdam UMC, University of Amsterdam, Department of General Practice, Cancer Center Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands l.s.bertels@amsterdamumc.nl.
• Ann Fam Med. 2022 Nov 1; 20 (6): 526534526-534.

PurposeWe aimed to assess participant-reported factors associated with non-follow-up with colonoscopy in colorectal cancer (CRC) screening.MethodsIn May 2019, we distributed a nationwide cross-sectional questionnaire (n = 4,009) to participants in the Dutch CRC screening program who received a positive fecal immunochemical test (FIT). Among respondents who reported no colonoscopy, we assessed the presence of a contraindication, and those without were compared with those who reported colonoscopy by logistic regression analysis.ResultsOf 2,225 respondents (56% response rate), 730 (33%) reported no colonoscopy. A contraindication was reported by 55% (n = 404). Decisional difficulties (odds ratio [OR] = 0.29; 95% CI, 0.18-0.47), lacking the opportunity to discuss the FIT outcome (OR = 0.45; 95% CI, 0.28-0.72), and a low estimated risk of CRC (OR = 0.45; 95% CI, 0.26-0.76) were negatively associated with follow-up. Knowledge items negatively associated with follow-up included having an alternative explanation for the positive FIT (OR = 0.3; 95% CI, 0.21-0.43), having trust in the ability to self-detect CRC (OR = 0.42; 95% CI, 0.27-0.65), and thinking that polyp removal is ineffective (OR = 0.59; 95% CI, 0.43-0.82). The belief that the family physician would support colonoscopy showed the strongest positive association with follow-up (OR = 2.84; 95% CI, 2.01-4.02) CONCLUSIONS: Because decisional difficulties and certain convictions regarding CRC and screening are associated with non-follow-up, personalized screening counseling might be an intervention worth exploring as a means of improving follow-up in the Dutch CRC screening program. Involving family physicians might also prove beneficial.© 2022 Annals of Family Medicine, Inc.

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