Emotional, behavioral barriers decrease FIT-based CRC screening by up to 47%
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Defensive strategies, such as denying immediacy of testing or exempting oneself, are key barriers to at-home colorectal cancer screening, according to study results published in Cancer.
“Various emotional and attitudinal barriers to colorectal cancer screening participation, including fatalism, a fear of cancer, a desire to not know if one has cancer, disgust, embarrassment and beliefs that screening will be uncomfortable or inconvenient, have been identified,” Nicholas Clarke, PhD, a post-doctoral researcher in the School of Psychology at Dublin City University, and colleagues wrote. “Other potential emotional and behavioral responses are emerging but have received less attention; one example is defensive information processing (DIP).”
Researchers define DIP “as a means by which individuals reduce negative psychological affect when they are faced with real or imagined threats (eg, cancer risk), including information or behavior that is inconsistent with their preferred view of the self.”
To evaluate how DIP might affect CRC screening, Clarke and colleagues surveyed 2,299 individuals invited to participate in a population-based, fecal immunochemical test (FIT) screening program in Dublin, who either participated (users = 1,988) or declined (nonusers = 311).
All individuals completed a questionnaire on the seven subdomains of the McQueen DIP measure, which included assessments on informational and behavioral avoidance, blunting, self-exemption, denying immediacy, message rejection and normalization of risk.
Studied outcomes included uptake status, the odds of not screening according to DIP score and behavioral factors associated with screening uptake.
After adjusting for sociodemographic factors, researchers reported that higher scores, defined as greater defensiveness, on all DIP domains were “significantly associated” with decreased screening uptake. Additional analyses adjusted for behavioral factors showed that suppression subdomains of denying immediacy (OR = 0.53; 95% CI, 0.43-0.65) and self-exemption (OR = 0.8; 95% CI, 0.68-0.96) independently predicted FIT-based screening nonuse.
Further, researchers noted that a one-unit increase in self-exemption and deny immediacy subscales correlated with 20% and 47%, respectively, lower odds of screening uptake.
“DIP, particularly suppression in the form of denying immediacy or self‐exemption, is a key barrier to organized FIT‐based screening uptake,” Clarke and colleagues concluded. “Suppressors who deny the immediacy to be screened may be amenable to behavioral interventions that nudge them to be screened. Suppressors who self‐exempt themselves may require stronger educational and defensiveness‐reducing interventions to encourage future screening participation.”
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