Top

BMC Public Health

Published in:

Open Access 01-12-2021 | Colorectal Cancer | Research article

Psychological distance: a qualitative study of screening barriers among first-degree relatives of colorectal cancer patients

Authors: Xueying Zhang, Yiheng Zhang, Jingyu Chen, Meifen Zhang, Ni Gong

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Colorectal cancer screening can reduce the incidence and mortality through early detection. First-degree relatives (FDRs) of patients with colorectal cancer are at high risk for colorectal cancer and therefore require colonoscopy. However, despite the high risk, screening adherence among FDRs remains low and the barriers to undergoing screening among FDRs in China are not clear. We explored the reasons why FDRs refused screening.

Methods

In this qualitative study, 28 semistructured, in-depth interviews were conducted face-to-face. Participants were recruited at two hospitals (an urban tertiary hospital and a community health center) in Guangzhou, South China. We used qualitative content analysis to analyze transcripts based on audio recordings and identify major themes and subthemes.

Results

Three major themes emerged related to FDRs’ low screening participation. First, the emotional distance between FDRs and medicine was pulled away by uncomfortable feelings approaching hospitals and misunderstanding of cancer. Second, they confirmed their health state and minimized cancer risk if they had no signs in routine health examination, no symptoms and maintained a healthy, happy life. Third, they considered screening far from their daily life from the perspective of spatial distance and priority. Therefore, screening was not necessary in their view.

Conclusions

Healthcare professionals should narrow psychological distance between people and screening when promoting screening technology.

Available only for authorised users

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.CrossRefPubMed

Zheng R, Sun K, Zhang S, Zeng H, Zou X, Chen R, et al. Report of cancer epidemiology in China, 2015. Zhonghua Zhong Liu Za Zhi. 2019;41(1):19–28. https://doi.org/10.3760/cma.j.issn.0253-3766.2019.01.005.CrossRefPubMed

Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):104–17. https://doi.org/10.3322/caac.21220.CrossRefPubMed

Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383(9927):1490–502. https://doi.org/10.1016/S0140-6736(13)61649-9.CrossRefPubMed

Chen FW, Sundaram V, Chew TA, Ladabaum U. Advanced-stage colorectal cancer in persons younger than 50 years not associated with longer duration of symptoms or time to diagnosis. Clin Gastroenterol Hepatol. 2017;15(5):728–737.e3. https://doi.org/10.1016/j.cgh.2016.10.038.CrossRefPubMed

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30. https://doi.org/10.3322/caac.21387.CrossRefPubMed

Atkin W, Wooldrage K, Parkin DM, Kralj-Hans I, MacRae E, Shah U, et al. Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK flexible Sigmoidoscopy screening randomised controlled trial. Lancet. 2017;389(10076):1299–311. https://doi.org/10.1016/S0140-6736(17)30396-3.CrossRefPubMedPubMedCentral

Barzi A, Lenz HJ, Quinn DI, Sadeghi S. Comparative effectiveness of screening strategies for colorectal cancer. Cancer. 2017;123(9):1516–27. https://doi.org/10.1002/cncr.30518.CrossRefPubMed

Roos VH, Mangas-Sanjuan C, Rodriguez-Girondo M, Medina-Prado L, Steyerberg EW, Bossuyt P, et al. Effects of family history on relative and absolute risks for colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019;17(13):2657–2667.e9. https://doi.org/10.1016/j.cgh.2019.09.007.CrossRefPubMed

10.

Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019;394(10207):1467–80. https://doi.org/10.1016/S0140-6736(19)32319-0.CrossRefPubMed

11.

Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal Cancer screening: recommendations for physicians and patients from the U.S. multi-society task force on colorectal Cancer. Am J Gastroenterol. 2017;112(7):1016–30. https://doi.org/10.1038/ajg.2017.174.CrossRefPubMed

12.

Chinese Society of Clinical Oncology. Guidelines of Chinese Society of Clinical: Colorectal Cancer. 2020. http://www.360doc.com/content/20/0429/09/40753533_909161151.shtml. Accessed 8 August 2020.

13.

Chen W, Li N, Lan P, Chen H, Du L, Sun F, et al. China guideline for the screening, early detection and early treatment of colorectal Cancer (2020, Beijing). Zhong Guo Zhong Liu. 2021;30(1):1–28. https://doi.org/10.11735/j.issn.1004-0242.2021.01.A001.

14.

Lowery JT, Ahnen DJ, Schroy PC 3rd, Hampel H, Baxter N, Boland CR, et al. Understanding the contribution of family history to colorectal cancer risk and its clinical implications: a state-of-the-science review. Cancer. 2016;122(17):2633–45. https://doi.org/10.1002/cncr.30080.CrossRefPubMed

15.

Koc S, Esin MN. Screening behaviors, health beliefs, and related factors of first-degree relatives of colorectal cancer patients with ongoing treatment in Turkey. Cancer Nurs. 2014;37(6):E51–60. https://doi.org/10.1097/NCC.0000000000000121.CrossRefPubMed

16.

Chen H, Li N, Ren J, Feng X, Lyu Z, Wei L, et al. Participation and yield of a population-based colorectal cancer screening programme in China. Gut. 2019;68(8):1450–7. https://doi.org/10.1136/gutjnl-2018-317124.CrossRefPubMed

17.

World Health Organization. Early diagnosis and screening. 2020. https://www.who.int/cancer/prevention/diagnosis-screening/screening/en/. Accessed 8 August 2020.

18.

Leung DY, Chow KM, Lo SW, So WK, Chan CW. Contributing factors to colorectal Cancer screening among Chinese people: a review of quantitative studies. Int J Environ Res Public Health. 2016;13(5):506. https://doi.org/10.3390/ijerph13050506.CrossRefPubMedCentral

19.

He L, Gao S, Tao S, Li W, Du J, Ji Y, et al. Factors associated with colonoscopy compliance based on health belief model in a community-based colorectal Cancer screening program Shanghai, China. Int Q Community Health Educ. 2020;41(1):25–33. https://doi.org/10.1177/0272684X19897356.CrossRefPubMed

20.

Leung DY, Wong EM, Chan CW. Determinants of participation in colorectal cancer screening among community-dwelling Chinese older people: testing a comprehensive model using a descriptive correlational study. Eur J Oncol Nurs. 2016;21:17–23. https://doi.org/10.1016/j.ejon.2015.11.004.CrossRefPubMed

21.

Tan KK, Lim TZ, Chan DKH, Chew E, Chow WM, Luo N, et al. Getting the first degree relatives to screen for colorectal cancer is harder than it seems-patients' and their first degree relatives' perspectives. Int J Color Dis. 2017;32(7):1065–8. https://doi.org/10.1007/s00384-017-2818-4.CrossRef

22.

Griffith KA, Passmore SR, Smith D, Wenzel J. African Americans with a family history of colorectal cancer: barriers and facilitators to screening. Oncol Nurs Forum. 2012;39(3):299–306. https://doi.org/10.1188/12.ONF.299-306.CrossRefPubMed

23.

Kroupa R, Ondrackova M, Kovalcikova P, Dastych M, Pavlik T, Kunovsky L, et al. Viewpoints of the target population regarding barriers and facilitators of colorectal cancer screening in the Czech Republic. World J Gastroenterol. 2019;25(9):1132–41. https://doi.org/10.3748/wjg.v25.i9.1132.CrossRefPubMedPubMedCentral

24.

Tan KK, Lopez V, Wong ML, Koh GC. Uncovering the barriers to undergoing screening among first degree relatives of colorectal cancer patients: a review of qualitative literature. J Gastrointest Oncol. 2018;9(3):579–88. https://doi.org/10.21037/jgo.2018.03.02.CrossRefPubMedPubMedCentral

25.

McGarragle KM, Hare C, Holter S, Facey DA, McShane K, Gallinger S, et al. Examining intrafamilial communication of colorectal cancer risk status to family members and kin responses to colonoscopy: a qualitative study. Hered Cancer Clin Pract. 2019;17(1):16. https://doi.org/10.1186/s13053-019-0114-8.CrossRefPubMedPubMedCentral

26.

Ingrand I, Dujoncquoy S, Beauchant M, Letard JC, Migeot V, Ingrand P. General practitioner and specialist views on colonoscopic screening of first-degree relatives of colorectal cancer patients. Cancer Epidemiol. 2009;33(3–4):223–30. https://doi.org/10.1016/j.canep.2009.07.002.CrossRefPubMed

27.

Tan KK, Lim TZ, Chew E, Chow WM, Koh GC. Colorectal cancer patients can be advocates for colorectal cancer screening for their siblings: a study on siblings' perspectives. Psychooncology. 2020;29(12):2028–32. https://doi.org/10.1002/pon.5496.CrossRefPubMed

28.

Liberman N, Trope Y. The role of feasibility and desirability considerations in near and distant future decisions: a test of temporal construal theory. J Pers Soc Psychol. 1998;75(1):5–18. https://doi.org/10.1037/0022-3514.75.1.5.

29.

Harada K, Lee S, Shimada H, Lee S, Bae S, Anan Y, et al. Distance to screening site and older adults' participation in cognitive impairment screening. Geriatr Gerontol Int. 2018;18(1):146–53. https://doi.org/10.1111/ggi.13133.CrossRefPubMed

30.

Veldwijk J, Groothuis-Oudshoorn CGM, Kihlbom U, Langenskiöld S, Dekker E, Kallenberg F, et al. How psychological distance of a study sample in discrete choice experiments affects preference measurement: a colorectal cancer screening case study. Patient Prefer Adherence. 2019;13:273–82. Published 2019 Feb 12. https://doi.org/10.2147/PPA.S180994.CrossRefPubMedPubMedCentral

31.

Crabtree B, Miller W. Doing qualitative research. second ed. Thousand Oaks, CA: Sage Publications; 1999.

32.

Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15. https://doi.org/10.1111/j.1365-2648.2007.04569.x.CrossRefPubMed

33.

Nooteboom B, Haverbeke WV, Duysters G, Gilsing V, Oord AVD. Optimal cognitive distance and absorptive capacity. Res Policy. 2007;36(7):1016–34. https://doi.org/10.1016/j.respol.2007.04.003.CrossRef

34.

Zhou W, Yang B, Wang Z, Zang Y. Evaluation of early cancer screening and routine medical examination. Article in Chinese. Med Philos. 2020;41(01):14–7. https://doi.org/10.12014/j.issn.1002-0772.2020.01.04.CrossRef

35.

Mastrokostas A, Gavana M, Gkrizioti M, Smyrnakis E, Cholongitas E, Benos A, et al. Discrepancies and misconceptions of perceived colorectal cancer screening barriers between primary health professionals and unscreened population. A comparative study in Greece. J BUON. 2018;23(7):67–76.PubMed

36.

China anti-cancer association. Hao xishan talked about the new trend of cancer prevention in People's daily online. 2020. http://www.caca.org.cn/system/2010/02/05/010041658.shtml. Accessed 11 March 2020.

37.

Cheng HB, Shek PK, Man CW, Chan OM, Chan CH, Lai KM, et al. Dealing with death taboo: discussion of do-not-resuscitate directives with Chinese patients with noncancer life-limiting illnesses. Am J Hosp Palliat Care. 2019;36(9):760–6. https://doi.org/10.1177/1049909119828116.CrossRefPubMed

38.

Moreno PI, Yanez B, Schuetz SJ, Wortman K, Gallo LC, Benedict C, et al. Cancer fatalism and adherence to national cancer screening guidelines: results from the Hispanic community health study/study of Latinos (HCHS/SOL). Cancer Epidemiol. 2019;60:39–45. https://doi.org/10.1016/j.canep.2019.03.003.CrossRefPubMed

39.

Sutkowi-Hemstreet A, Vu M, Harris R, Brewer NT, Dolor RJ, Sheridan SL. Adult Patients' perspectives on the benefits and harms of overused screening tests: a qualitative study. J Gen Intern Med. 2015;30(11):1618–26. https://doi.org/10.1007/s11606-015-3283-9.CrossRefPubMedPubMedCentral

40.

Potter EC, Allen KR, Roberto KA. Agency and fatalism in older Appalachian women's information seeking about gynecological cancer. J Women Aging. 2019;31(3):192–212. https://doi.org/10.1080/08952841.2018.1434951.CrossRefPubMed

41.

Oh KM, Park B, Jacobsen KH. A qualitative analysis of barriers to colorectal Cancer screening among Korean Americans. J Cancer Educ. 2019;36(2):261–70. https://doi.org/10.1007/s13187-019-01621-3.CrossRef

42.

Lee SY. Koreans’ awareness and preventive behaviors regarding colorectal cancer screening. Asian Pac J Cancer Prev. 2018;19(9):2657–64. https://doi.org/10.22034/APJCP.2018.19.9.2657.CrossRefPubMedPubMedCentral

43.

Wakslak CJ, Trope Y, Liberman N, Alony R. Seeing the forest when entry is unlikely: probability and the mental representation of events. J Exp Psychol Gen. 2006;135(4):641–53. https://doi.org/10.1037/0096-3445.135.4.641.CrossRefPubMed

44.

Bai Y, Wong CL, He X, Wang C, So WKW. Effectiveness of tailored communication intervention in increasing colonoscopy screening rates amongst first-degree relatives of individuals with colorectal cancer: a systematic review and meta-analysis. Int J Nurs Stud. 2020;101:103397. https://doi.org/10.1016/j.ijnurstu.2019.103397.CrossRefPubMed

45.

Worthley DL, Cole SR, Esterman A, Mehaffey S, Roosa NM, Smith A, et al. Screening for colorectal cancer by faecal occult blood test: why people choose to refuse. Intern Med J. 2006;36(9):607–10. https://doi.org/10.1111/j.1445-5994.2006.01155.x.CrossRefPubMed

46.

Bie AKL, Brodersen J. Why do some participants in colorectal cancer screening choose not to undergo colonoscopy following a positive test result? A qualitative study. Scand J Prim Health Care. 2018;36(3):262–71. https://doi.org/10.1080/02813432.2018.1487520.CrossRefPubMedPubMedCentral

47.

Williams RM, Wilkerson T, Holt CL. The role of perceived benefits and barriers in colorectal cancer screening in intervention trials among African Americans. Health Educ Res. 2018;33(3):205–17. https://doi.org/10.1093/her/cyy013.CrossRefPubMedPubMedCentral

48.

Parke MR, Weinhardt JM, Brodsky A, Tangirala S, DeVoe SE. When daily planning improves employee performance: the importance of planning type, engagement, and interruptions. J Appl Psychol. 2018;103(3):300–12. https://doi.org/10.1037/apl0000278.CrossRefPubMed

49.

Li T, Nakama H, Wei N. Reasons for non-compliance in colorectal cancer screening with fecal occult blood test. Eur J Med Res. 1998;3(8):397–400.PubMed

50.

Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, et al. Clinical inertia. Ann Intern Med. 2001;135(9):825–34. https://doi.org/10.7326/0003-4819-135-9-200111060-00012.CrossRefPubMed

51.

Biswas J. Debunk the myths: oncologic misconceptions. Indian J Med Res. 2014;139(2):185–7.PubMedPubMedCentral

Title: Psychological distance: a qualitative study of screening barriers among first-degree relatives of colorectal cancer patients
Authors: Xueying Zhang
Yiheng Zhang
Jingyu Chen
Meifen Zhang
Ni Gong
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-10786-w

2024 ASCO Annual Meeting

Springer Medicine

Psychological distance: a qualitative study of screening barriers among first-degree relatives of colorectal cancer patients

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

The impact of teenage pregnancy on school dropout in Brazil: a Bayesian network approach

Impact of early life famine exposure on adulthood anthropometry among survivors of the 1983–1985 Ethiopian Great famine: a historical cohort study

Knowledge, attitudes and perceptions towards COVID-19 vaccinations: a cross-sectional community survey in Bangladesh

Sociodemographic factors associated with acceptance of COVID-19 vaccine and clinical trials in Uganda: a cross-sectional study in western Uganda

Adverse childhood experiences and future self-rated health: a prospective cohort study

Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study