Screening for colorectal cancer: how can we maximize uptake?

摘要

Screening for colorectal cancer is being introduced in a number of countries, yet uptake remains low. The rationalistic model of screening participation explains low uptake in terms of deficient knowledge and high cost. There is evidence to support this view and remedial actions produce anticipated effects up to a point. However, differential uptake among specific groups suggests that the individual decision to participate in screening is idiosyncratic, and understanding decisions requires interpretation in terms of message framing, reference points, the use of simplifying heuristics and affective or emotional reaction. As these aspects of decisions originate from fundamental personal characteristics, they may be difficult to combat. When decision determinants, such as fear and herding, are manipulated, consequences for uptake can be contradictory.