Declining the offer of flexible sigmoidoscopy screening for bowel cancer: a qualitative investigation of the decision-making process

Qualitative methods were used to investigate decision-making among a group of older adults who declined the offer of flexible sigmoidoscopy screening for bowel cancer. Interviews were conducted with 60 people (30 men and 30 w omen) who either had not responded to the screening letter or who responded saying that they were not interested in participating. The findings sugges t that low perceived susceptibility to bowel cancer, in terms of current he alth status, family history or absence of bowel symptoms, was an important factor in the decision to decline screening. Procedural barriers such as em barrassment, pain/discomfort and perceived unpleasantness of the test were reported as relatively minor, although the test was considered more physica lly intrusive than other screening tests. Avoidant attitudes emerged as an important theme and were reported by a third of respondents. Distinct patte rns of decision-making were also observed and three groups emerged from acc ounts: (ij forgetting or avoiding making a decision about the test (ii) a c onfident rejection of the test based on a few salient factors, and (iii) a more careful consideration of the test focusing on issues of susceptibility . The findings are discussed in the context of models of health behaviour a nd bowel cancer screening participation research. (C) 2001 Elsevier Science Ltd. All rights reserved.