152 Chapter 6 of developing the screening-specific tumours, who often live in relatively disadvantaged lower SES-neighbourhoods, participate in the CSPs. There is evidence in the literature that GPs are able to increase screening participation among people at higher risk, which was mostly achieved by approaching and inviting people selectively.25, 26 GPs were found to be most familiar with the cervical CSP, which is not surprising, since current GP involvement is most prominent in this CSP.5 GPs seemed to be especially interested in CSP aiming at breast cancer, as they were most interested in knowing who had an abnormal mammogram and were most willing to discuss positive screening outcomes with patients themselves. This is likely related to how serious positive screening outcomes are valued by GPs. Earlier research described that GPs value a positive FIT outcome much less serious, than a positive mammography outcome,27 as was also stated by several GPs included in our study. GPs appeared to be less familiar with the CRC-SP, which is most likely related to the novelty of the programme.5 A study focused on the CRC-SP concluded that GPs should take on a ‘guidance-role’ concerning possible false-positive CRC screening outcomes.28 Responding GPs in our study explicitly stated that they like such a ‘guidance-role’, and do see this as a GP’s task. We therefore believe that such a guidance role of GPs could be applied to the entire portfolio of the CSPs. Regarding our study there are certain issues which need to be reflected on. First, our questionnaire yielded a response rate of 42%, which is comparable with the results of other questionnaires searches among physicians.29 With (online) questionnaires, there is always a potential risk of selection bias.30 In our case, it could be that GPs who consider the CSP important participated in our study. However, as the results of the interviews align with the results of the questionnaire, we believe that we managed to minimize this risk. Second, during the interviews, we noticed that several GPs sometimes lacked parts of necessary background information to answer certain questions. For instance, most GPs assumed that they would always be informed when a patient had a positive FIT result; which is not the case (see Table 1). As described earlier, this constitutes an outcome of our study; yet it also impedes a more profound exploration of certain topics. For forthcoming studies, it could be crucial to consider that the average GP may not possess a comprehensive understanding of the organization of the CSPs. Third, during the interviews, it emerged that GPs had not always thoroughly considered their reasons for wanting certain information. For example, they regularly indicated that they wanted to know all on who had been invited, as well as on the outcomes of all screening tests. However, when we further probed into what they intended to do with this information, clear answers were not always provided. Fourth, for this study, we used a f convenience sample, due to logistical and time-related issues. Although most interviews yielded about the same answers, we cannot state that we achieved data saturation, as is often aimed for
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