147 Perceptions and beliefs of GPs on the CSPs Results After an online invitation of 110 GPs, a total of 46 GPs completed the online questionnaire (response rate 42%), with a mean age of 51 years (ranging from 36-68 years). Most of the respondents were female (72%) and had more than 10 years of working experience (85%). Twenty-six percent of the GPs, the largest group, were working in the greater city of The Hague. Most GPs described their population as average regarding age and educational level, and predominantly as having a Dutch cultural background (Supplementary Table 2). Subsequent five semi-structured interviews (convenience sample), ranging from 37-46 minutes, were conducted. The interviewed GPs had comparable characteristics to those of the questionnaire responders (Supplementary Table 3). The cancer screening programmes (CSPs) were stated as an important and repeating topic in daily practice, and most GPs receive questions regarding the CSPs on a regular basis (Table 2). During the past year, 89% of the GPs received questions concerning the cervical CSP, 70% concerning the breast CSP, and 85% concerning the CRC-SP. Most questions, across all three CSPs, related to the outcomes of the screening test(s) and potential follow-up examinations, with particular emphasis on the self-sampling test for cervical CSP. GPs reported to be most familiar with the cervical CSP, regarding the objective and practice manual of the CSP, and their intended role. Only 69% of the GPs reported being familiar with their role regarding the CRC-SP, compared with 80% for the two other CSPs. Nevertheless, almost all GPs thought that their knowledge and practice policies were sufficient and accurate concerning all three CSPs. Nevertheless, the interviews revealed that GPs, on average, lack specific knowledge on various issues, including when the GP is informed and who is responsible for arranging the referral (Q3, Q21, Q49). Regarding the way GPs discuss and value the CSPs, approximately 80% of GPs indicated that they actively promote patient involvement in CSPs. Most GPs maintain a positive attitude toward patient participation, with 69% expressing the belief that encouraging cancer screening is always the appropriate course of action (Q8, Q16). Only 4% of the GPs occasionally discouraged patients from participating in a CSP. In the interviews it was explained that this occurred when patients struggled with extensive comorbidities or were already involved in (other) intensive medical trajectories. More than half (57%) of the GPs indicated that they mentioned the CSPs sometimes during consultation, even without the patient explicitly asking. From the interviews, it emerged that this was usually related to certain symptoms, such as: vaginal bleeding, a breast lump, or bowel related problems. Conversely, it also occurred that talking about the CSPs served as starting point for discussing other ‘intimate’ topics (Q16). Sixty-four percent of 6
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