144 Chapter 6 a From 2017 onward, women can opt to receive a self-sampling test (after being invited). The outcome of the self-sampling test is not automatically shared with the GP due to privacy legislation. Outcomes will only be shared with the GP if it is explicitly stated that the GP is allowed to receive this information. Hence, the GP no longer plays an essential role in this CSP. If HVP is detected, women are recommended to contact their GP to have a smear test taken at the GP practice. b In cases where no abnormalities are detected, the GP will not be involved. c Since 2017, the GP no longer automatically receives the outcome of a FIT. Outcomes will only be shared with the GP if it is explicitly stated that the GP is allowed to receive this information. After a positive FIT patients are encouraged to seek contact with their GP. High participation rates are essential for a CSP to be effective. According to the World Health Organization (WHO), at least 70% of the target population should be screened in order to be beneficial at the population level.9-11 Throughout Europe participation in CSPs varies substantially, yet the Netherlands has always been known for its high screening attendance and adherence.12 The most recent nationally available attendance rates – registered before the COVID-19 pandemic – were 56.0%, 76.0% and 71.8% for the SPs aimed at cervical, breast and CRC, respectively.6-8 Although the attendance rates of two programmes are above the recommended rate from WHO, there is an alarming downward trend and wide regional variation in screening uptake.13 In 2010, the uptake rates of the CSPs for cervical and breast cancer were 65.5% and 80.7%, respectively.6, 7 Since the colorectal CSP has only been fully operational since 2019, it is too early to draw any conclusions on trends regarding this screening programme. The lowest attendance rates are found in the four large cities of the Netherlands and fall, for all three programmes, below the minimal intended rate of 70%.4 This seems to coincide with a relatively higher incidence and related late-stage diagnoses in the same areas.14 Hence, efforts should be made to optimize current screening uptake, especially for individuals who currently do not engage in the CSPs. General Practitioner (GP) involvement is recognized for its ability to influence screening uptake, mostly by stimulating screening participation.15-18 Within the Netherlands, GP involvement was earlier described as beneficial for the classical, ‘hard to reach’, subpopulations.13 Thereby, the Dutch are known for placing trust in and maintaining good long-term relationships with their GPs.19 Despite these factors, the extent of GP involvement in the CSPs remains limited, varies between the different programmes and has changed over time.13 Unexplored is what GPs think of their role(s) in the CSPs. This study aims to fill this knowledge gap by mapping the perceptions and beliefs of GPs regarding their current and future role in the Dutch CSPs. With the long-term objective in mind that GP-involvement in the CSPs could potentially boost screening attendance.
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