Self-sampling in screening to reduce mortality from colorectal cancer: a qualitative exploration of the decision to complete a faecal occult blood test (FOBT)

Objective: To explore beliefs that might impact upon public reactions to a proposed population level faecal occult blood test (FOBT) screening invitation and acceptability of completing an FOBT home self-sampling kit. Methods: Four focus groups were conducted to explore men and women's beliefs about colorectal cancer risk, their understanding of screening and reactions to an FOBT kit. Participants were shown a kit and permitted to examine it during the focus groups. Results: Colorectal cancer is viewed as having severe quality of life impacts and is commonly regarded as being caused by diet. Faecal blood is an expected symptom. A home self-sampling kit is viewed as highly acceptable, but some concerns were raised about collecting and storing faecal matter. Conclusions: The main implications for public education arising from the analysis were firstly, that communications regarding the potential to avoid quality of life impacts of colorectal cancer may motivate participation; secondly, that public education might address the ability of the test to detect asymptomatic abnormalities, in particular occult (as opposed to visible) blood; thirdly, in order to prevent avoidance responses to fear, communications need to emphasise that many abnormal test outcomes will not be cancer and early treatment may prevent cancer and associated adverse quality of life impacts; fourthly, that uptake may be promoted by emphasising messages that the test kit is very convenient; and finally, that instruction leaflets might minimise procedural concerns by suggesting simple and easy methods to collect and store faecal samples.