15 General introduction The story of the Janssens family – The Questions The Janssen family lives in a big city in the Western part of the Netherlands. The family consists of three members: Maria, the mother, 54 years old; John, the father, 59 years old; and their daughter Sarah, 30 years old. They all see their general practitioner (GP) because they have questions concerning the cancer screening programmes (CSPs). Sarah just recently received an invitation to participate in the CSP aiming at cervical cancer. Maria and John recently had a discussion on participating in the colorectal cancer (CRC) screening programme (SP). When Sarah consults the GP, she indicates that she does not know whether she wants to participate in the SP. She has read several stories on the internet, including that it has to do with changing sexual partners. Sarah just had one and the same boyfriend for many years now. Sarah tells the GP, that her mother Maria said to not act so weird and that she should ‘just participate’. Maria’s argumentation is: “The CSPs are very important and for a serious cause, so why not just participate?”. Sarah does agree that the programmes are for a serious case, but also wonders about the disadvantages of participating. Thereby she read something about the self-sampling test, but she doubts that she is able to perform it herself. When Maria gets invited for one of the CSPs, she always faithfully participates. She does think the CSPs are a bit of a hassle, but afterwards she is always relieved when nothing abnormal is found. When Maria and John visit the GP, John mentions that he recently received an invitation (he might have overlooked an earlier invitation) to participate in the CSP on CRC. He indicates that he does not understand what he has to do with the stool test, and in addition, he says he was very surprised that he was suddenly invited. He thinks it is really strange that he actually never heard about the CSPs before. The GP answers the family’s questions as best as possible, but after the consultations he starts thinking on the advises and about the CSPs in general. Does Sarah have a point that it does not actually make sense for her to participate in the SP? What are actually the benefits and harms of participating in CSPs? Is it still best practice for everyone to always participate, thinking about Maria? Or is there any evidence why people are sometimes better off not participating? And what about John. Would there be many people who do not understand the invitation and have no idea about the CSPs at all? Finally, what is actually his role as a GP regarding the CSPs? Are the programmes organised efficient and effective, and as a GP, should he actually have a role in the CSPs? 1
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