Article Figures & Data
Tables
- Table 1.
Characteristics of FG participants: Percentages do not add to 100% owing to rounding.
CHARACTERISTIC HAMILTON FG1 (N = 11) HAMILTON FG2 (N = 6) OTTAWA FG1 (N = 10) OTTAWA FG2 (N = 10) THUNDER BAY FG1 (N = 11) THUNDER BAY FG2 (N = 10) TOTAL (N = 58) Sex, n (%) • Male 7 (64) 2 (33) 6 (60) 4 (40) 5 (45) 2 (20) 26 (45) • Female 4 (36) 4 (67) 4 (40) 6 (60) 6 (55) 8 (80) 32 (55) Median (IQR) age, y 65 (61–69) 59 (55–60) 60 (53–70) 65 (59–66) 60 (58–68) 60 (58–66) 60 (60–63) Working, n (%) • Yes 5 (45) 5 (83) 5 (50) 3 (30) 6 (55) 5 (50) 29 (50) • No 6 (55) 1 (17) 5 (50) 7 (70) 5 (45) 5 (50) 29 (50) Education, n (%) • High school or less 8 (73) 2 (33) 2 (20) 0 (0) 4 (36) 2 (20) 18 (31) • Some college or university 0 (0) 1 (17) 1 (10) 0 (0) 2 (18) 1 (10) 5 (9) • Completed college or university 3 (27) 3 (50) 7 (70) 10 (100) 5 (45) 5 (50) 33 (57) • Unknown 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 2 (20) 2 (3) Ethnicity, n (%) • White 11 (100) 6 (100) 9 (90) 8 (80) 10 (91) 8 (80) 52 (90) • Native Canadian or aboriginal 0 (0) 0 (0) 0 (0) 0 (0) 1 (9) 0 (0) 1 (2) • Mixed (black and white) 0 (0) 0 (0) 1 (10) 0 (0) 0 (0) 0 (0) 1 (2) • South Asian 0 (0) 0 (0) 0 (0) 1 (10) 0 (0) 1 (10) 2 (3) • Middle Eastern 0 (0) 0 (0) 0 (0) 1 (10) 0 (0) 0 (0) 1 (2) • Asian 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (10) 1 (2) Type of previous screening,* n (%) • FOBT 8 (73) 2 (33) 7 (70) 3 (30) 5 (45) 4 (40) 29 (50) • Colonoscopy 0 (0) 1 (17) 0 (0) 1 (10) 0 (0) 0 (0) 2 (3) • FOBT and colonoscopy 2 (18) 0 (0) 3 (30) 4 (40) 0 (0) 1 (10) 10 (17) • Screened, exact test not known 0 (0) 0 (0) 0 (0) 1 (10) 5 (45) 2 (20) 8 (14) • None 0 (0) 3 (50) 0 (0) 1 (10) 0 (0) 2 (20) 6 (10) • Previous screening history unknown 1 (9) 0 (0) 0 (0) 0 (0) 1 (9) 1 (10) 3 (5) -
FG—focus group, FOBT—fecal occult blood testing, IQR—interquartile range.
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* Patients were asked about any previous screening, not just screening related to the ColonCancerCheck Primary Care Invitation Pilot.
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- Table 2.
Participants’ attitudes toward the ColonCancerCheck Primary Care Invitation Pilot
THEME SELECTED QUOTATIONS FROM FG PARTICIPANTS Invitation letter reaction -
I don’t remember … I have everything filed and I went through the medical file and I can honestly say that, as far as I know, 100% I did not see this letter. (FG1, Ottawa, Ont)
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My doctor for the last 2 years has been mentioning that I should do one of those kits and I’m a procrastinator and I don’t go and pick it up. I saw this [letter] and I thought, “Oh yeah, I’ve got to pick that up.” (FG2, Thunder Bay, Ont)
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My doctor just said you’re at that age and you should go get this done … he’s pretty knowledgeable so I thought, “Yeah, this is a good idea.” So when it [the letter] came in the mail, I read the stuff. So it reinforced me. His opinion reinforced the process. (FG1, Thunder Bay)
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[It] came out of the blue. I’m wondering why the doctor that … never talks to you much … sends … a letter saying you should come in and talk about … colonoscopy. I was in a … state of panic: “What’s going on here; what isn’t he saying?” (FG2, Thunder Bay)
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What threw me off was, “Please call my office for an appointment,” because I had just been there and thought, “Who’s this letter from, actually?” (FG2, Hamilton, Ont)
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[I did] exactly what I do to any mail-out I get, I put it in a little pile ... and never see it any more. (FG1, Hamilton)
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I wouldn’t have even brought it up to my family physician if I hadn’t received the letter. That’s what I needed—a trigger. (FG2, Hamilton)
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I remember getting it and it was very clear and I acted on it. (FG1, Ottawa)
Suggestions about changing the invitation letter format and content -
If the doctor’s name hadn’t been on the bottom I’d … give it a toss. (FG1, Thunder Bay)
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The fact that your own doctor’s name is on there, makes it a little more personal. (FG1, Hamilton)
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[I found it] very confusing that it’s coming from my doctor … [it] should be coming … from Cancer Care Ontario … and … say, “On behalf of your doctor.” (FG1, Ottawa)
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Put … in the first paragraph ... [that] it’s a simple test that can be done at home. (FG1, Hamilton)
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If the letter is going to work, it’s got to be more scary … powerful … you need to give people something to grab onto at the very beginning like … that this simple little test could save your life. (FG1, Ottawa)
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I like lots of information. There wasn’t enough information in this for me. (FG1, Thunder Bay)
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I still was wondering how prevalent it [colorectal cancer] was and I was thinking it would be nice to know that ... to know it [screening] was something that would make a difference or not. (FG1, Thunder Bay)
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It says I’ve missed the FOBT … and then you should have a … colonoscopy. Now it says if you’re at risk … you really should have [a colonoscopy] but if I’m average do I still get one? (FG2, Thunder Bay)
FOBT responses and experiences Motivators to use FOBT
Personal health factors-
[I am] getting older … a few years ago I didn’t want to … but now I do. (FG1, Thunder Bay)
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I have family that has colon cancer. (FG1, Thunder Bay)
Social factors-
My wife wanted me to. (FG2, Hamilton)
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[I have] relatives that had cancer ... and my husband’s sister died of colon cancer … so did his father. That’s enough … fear … for me to do the screening … going to be safe [rather] than sorry. (FG1, Thunder Bay)
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I needed a little push, which I got from my union and I got from this letter. (FG1, Hamilton)
Health system interventions-
My physician … directed me to have the stool test. (FG1, Ottawa)
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My doctor just gave me this kit, I did the test and … put it in the mailbox. (FG2, Thunder Bay)
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I saw the commercial on TV, so I asked my doctor for the envelope to do the stool test. (FG1, Ottawa)
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I can honestly say I would have never have gone if I didn’t get this letter … it was a trigger that reminded me. (FG1, Ottawa)
Barriers to FOBT-
Once you got past the yuck factor … it was pretty simple. (FG1, Hamilton)
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I didn’t really like the whole process … I thought, “That’s disgusting.” (FG2, Hamilton)
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What bothered me more was what I could eat or not eat. (FG1, Hamilton)
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It’s like a fear thing … if I do the FOBT and something shows up … then I have a colonoscopy. (FG2, Hamilton)
Receiving results-
I don’t remember getting the results. (FG1, Ottawa)
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I thought since I sent in the test that I would get results but then I thought, “Well, maybe my doctor got the results,” and since she never … they never call if it’s negative. (FG1, Ottawa)
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The first time I had … [FOBT] done and he [physician] called me into the office to say it was negative and I said, “Well, that’s a waste of time.” So, this time when I did get [the results] in the letter form, I felt it was better because I wasn’t wasting up valuable doctor time. (FG1, Ottawa)
Direct mailing of FOBT kit -
If ... kits are sent … directly, you’d have a lot more people participating. (FG1, Hamilton)
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If it [the kit] would come in the mail, I’d say, “Oh, I got this, I’d better do it.” (FG1, Thunder Bay)
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If they sent me the kit the first time I wouldn’t have done it … because I’ve done it once, I’ll do it again. (FG1, Thunder Bay)
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My doctor gets me all the tests … more tests than I want already and I don’t need this. It’s a waste, sending it to me. (FG2, Ottawa)
Screening promotion strategies Strategies that would be novel to the ColonCancerCheck program -
If you use the educational system to get the information out, also you’re going to reach the parents of these children that are [minority] ethnic cultures. (FG2, Ottawa)
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Gyms and sporting areas. That’s big … getting fit again. Health clubs, gymnasiums ... (FG1, Ottawa)
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The Internet. That’s what everybody’s looking at. (FG1, Hamilton)
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What about … e-mail, with a link to a website that has some testimonials of people that had the test, didn’t have the test, what it
feels [like]. (FG2, Hamilton)
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They are the minority so maybe something specific to get males to go might be [a possible strategy]. (FG2, Thunder Bay)
Strategies previously or currently used by program-
Oh, maybe part of the medical … just automatically give you the kit at your yearly medical. (FG2, Thunder Bay)
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When you’re standing at the pharmacy waiting for your prescription to be picked up, if something like this could be there. (FG2, Ottawa)
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If you could have them hand them [FOBT kits] out with the prescriptions, put one in with the prescriptions. (FG1, Thunder Bay)
Birthday invitation-
Sure, I think that would be a good idea because a lot of people … reach 50 and they don’t realize that that’s the time you start all these preventative tests. There’s a whole list of things you could do when you turn 50 [that] would be good. (FG1, Thunder Bay)
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It kind of smacks of Cracker Barrel … [a] little cheesy. (FG2, Hamilton)
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FG—focus group, FOBT–fecal occult blood testing.
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