149 Perceptions and beliefs of GPs on the CSPs GPs concurred that they are not responsible for screening uptake (Q5, Q11). However, in the case of a positive screening outcome for an individual patient, GPs do acknowledge a sense of responsibility. This is especially evident in guiding the patient and composing referral letters (Q13) (where the latter does not apply to the CRC-SP). Topic II: Informing of GPs GPs seemed to be divided regarding their preference for knowing the individuals invited by the screening organization. Approximately half of the questionnaire respondents were in favour of knowing this information, and some explicitly wrote this down in the openended question section. During the interviews, some stated they want to know all on attenders and non-attenders (GP IV and GP V), whereas others were more hesitant (GP I-III). This is illustrated by quotes 19, 23 and 25: “I would like to know who did and did not participate. Now I have no clue, and therefore cannot act on it. If I knew, then I would be much better able to proactively engage with people concerning the CSPs”, ‘versus’ quotes 18 and 20: “I am not sure if I want to know when someone has not participated. It remains a patient’s own choice. Knowing this can be perceived as intrusive. ... Then, it may no longer feel like a free choice, but much more like coercion…”. Several technical methods have been suggested to better inform GPs on screening attendance and outcomes; such as making use of the GP’s IT-systems (Q26), or by an opt-out based invitation system (Q27). By the latter, the interviewee meant that GPs receive information about patients’ CSP attendance by default, unless patients explicitly object. In the questionnaire, 73% of the respondents indicated that they want to know who had a positive screening outcome for the cervical CSP, 83% for the breast CSP, but only 43% for the CRC-SP. As became from the interviews, the lower percentage for the CRC-SP may stem from the perception that a positive Faecal Immunochemical Test (FIT, formerly the iFOBT) is considered less serious than a positive outcome in the other two CSPs. In addition, GPs were found to be less willing to inform patients after a positive FIT outcome. Finally, certain GPs interviewed expressed concerns that being aware of individuals who did not participate in the CSPs might result in an increased workload (Q17, Q22, Q24). They believed that this knowledge would entail additional responsibilities, such as actively reaching out to those who did not attend. Topic III: Inviting via GP-practices As in the past, screening-eligible people were invited via GP-practices for the cervical CSP, we questioned GPs on this topic. In the questionnaire 63% of the respondents declared they used to invite patients via their GP-practice for the cervical CSP, while 18% reported: ‘unknown to me’. Only a minority (20%) of GPs currently favoured inviting patients via GP-practices. During the interviews, none of the GPs appeared to be willing to (re-)start the invitation procedures primarily via GP-practice. Indicated reasons were mostly: lack 6
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