Factors affecting compliance in colorectal cancer screening. Results of a study performed in Ballarat.

Non-compliance in screening programmes for colorectal cancer is likely to be the most important factor limiting the impact of screening on mortality. This study aimed to determine risk factors and correlates of compliance that could be readily identified by general practitioners. A total of 581 eligible subjects aged 40 to 75 years completed a questionnaire that covered demographic factors, personal medical history, family history of colorectal cancer and smoking status. Faecal occult blood tests were then offered by the general practitioner and compliance correlated with responses. The over-all compliance was 44% and increased to 51% for those who accepted the self-testing kit at consultation. For men, compliance increased with increasing level of education and was significantly greater for non-smokers than for smokers. For women, compliance increased with increasing age, and was greater for those with either symptoms and/or a family history of colorectal cancer. A doctor group-practice factor appeared to influence acceptance versus refusal of the test kit from the doctor. A triage approach to screening in general practice may improve over-all compliance and the yield of tumours. With this strategy, patients at high risk (for example, those with a family history of colorectal cancer or in older age groups) are identified first. Particular attention should be given during consultation to those at high risk who have poor compliance profiles (for example male smokers with a family history of colorectal cancer). High-risk subjects with high compliance profiles would need less attention and low-risk individuals would need least attention.

Predicting colon cancer screening behavior from health beliefs.

A total of 581 people (33% male, 67% female) attending general practitioners completed a questionnaire mainly on health beliefs and were then offered a fecal occult blood test (Hemoccult II) free of charge. Eighty-six percent accepted the general practitioners' offer and took the Hemoccult kit home. Of these, 51% complied (i.e., returned specimens for laboratory testing). The Health Belief Model was found to account for 12% of the variance in screening behavior. Perceived barriers to taking the test and perceived susceptibility to bowel cancer were the only components contributing significantly in the multiple regression analysis. Health Belief Model components that were predictive of initial acceptance of the test offer differed from components predictive of ultimate compliance. The influence upon compliance of family history of colorectal cancer, history of colonic symptoms, smoking habits, perceived attitudes of spouses, attitude to detection tests, and subjective stress related to the threat of bowel cancer were also investigated.