Perceived colorectal cancer candidacy and the role of candidacy in colorectal cancer screening

Abstract

Screening is a well-established tool to advance earlier cancer diagnosis. We used Davison's concept of 'candidacy' to explore how individuals draw on collectively constructed images of 'typical' colorectal cancer (CRC) sufferers, or 'candidates', in order to evaluate their own risk and to ascertain the impact of candidacy on screening participation in CRC. We interviewed 61 individuals who were invited to participate in the Scottish Bowel Screening Programme. Of these, 37 were screeners (17 men and 20 women) and 24 non-screeners (13 men and 11 women). To analyse these data we used a coding frame that drew on: symptoms, risk factors, and retrospective and prospective candidacy. Few participants could identify a definite bowel cancer candidate and notions of candidacy were largely predicated on luck in the sense that anyone could be a candidate for CRC and there was little evidence to support a linear relationship between feelings of risk and screening decisions. Often participants described screening as part of a wider portfolio of being healthy and referred to feeling obliged to look after themselves. Our study suggests that rather than candidates for bowel cancer, screeners viewed themselves as candidates for screening by which screening decisions pointed towards the acceptance and normalisation of the rhetoric of personal responsibility for health. These findings have related theoretical and practical implications; the moral structure that underpins the new public health can be witnessed practically in the narratives by which those who see themselves as candidates for screening embrace wider positive health practices.

Understanding Patient Factors to Increase Uptake of Cancer Screening: a Review

“…Perceptions of greater cancer risk are associated with participation in breast [104] and colorectal cancer screening [64], but individuals can have an optimistic bias about their cancer risk [105]. Qualitative research has found that there are benchmarks, or 'candidates,' against which people measure their personal risk, which influences screening attendance decisions [106,107]. Risk perceptions can be closely related to illness beliefs, such as the perceived severity of cancer, and known risk factors, such as family history of cancer and tobacco use, and can generate an emotional response, or 'affective risk perception' [108].…”

Why do people take part in atrial fibrillation screening? Qualitative interview study in English primary care

“…Informing participants’ consideration of the harms and benefits of screening was an assumption that taking part in screening was something they ought to do, corresponding with evidence from screening decision-making studies 53 59–62. Sociological work has shown how screening participation is associated with maintaining, and being responsible for, one’s own health,30–38 and part of patients’ efforts to be a ‘good patient’ and to use healthcare resources appropriately 63…”

“…We developed key themes through consensus meetings between SH, AP and JB, and SH then explored these themes within the wider dataset to establish the veracity of key themes and identify deviant cases, with the themes subsequently refined. These themes were synthesised to understand shared views of screening participation, aided by reference to social science and health screening literature about participation in screening 30–38…”

Revisiting Candidacy: What Might It Offer Cancer Prevention?

“…Javanparast et al [ 18 ] and Ward et al [ 17 ] identified components of lay epidemiology that acted as barriers or enablers for screening; experiencing colorectal cancer in your close networks and having heard about the program facilitated an understanding of screening need, whilst those who held fatalistic views regarding cancer were less likely to see a need to attend screening. Bikker et al [ 96 ] conducted 61 in-depth interviews with men and women who identified themselves as either colorectal screeners or non-screeners to more closely explore components of candidacy. Findings were consistent with Macdonald et al [ 62 ] in that cancer fear was commonly described; it was difficult to illustrate a type of person who was a candidate; and participants’ views of anomalous cases and risk perceptions were wide.…”

“…Findings were consistent with Macdonald et al [ 62 ] in that cancer fear was commonly described; it was difficult to illustrate a type of person who was a candidate; and participants’ views of anomalous cases and risk perceptions were wide. There was a common belief that ‘anyone can be a candidate for cancer’ [ 96 ] (p. 360) and, again, participants were reluctant to assign candidacy to themselves or others, although they were more likely to see themselves as candidates for screening.…”