189 General discussion during the medical training and EHR systems should be further improved in supporting the coding facilities during routine care. An earlier study examining the quality of cancer registration in primary care, based on International Classification of Primary Care (ICPC) codes,39 revealed that approximately 40% of cancer cases cannot immediately be recognized in the coded registrations, and almost half of the cases is coded prematurely and based on hypothesis, resulting in false positive cancer diagnoses.40, 41 In that respect, there is still much to be gained in terms of proper coding, while also inadequate coding support that the EHRs still present to the users, should be reduced. A last recommendation for GPs and primary healthcare providers has to do with the advice they are providing screening-eligible people who have questions about the CSPs. What we have noticed is that many people, and the majority of healthcare providers we have spoken to, hold rather positive views on the CSPs.9, 42, 43 However, screening can also have certain harmful effects. Since clinicians are primarily concerned with the health of their patients, a good understanding of the pros and cons of the CSP is essential and physicians should be able to provide patients with complete and accurate information. In daily practice most significant negative effects of the CSPs are the amounts of overdiagnosis and overtreatment.44, 45 Implications for policymakers For policymakers, import recommendations align with the recommendations for researchers. The need to allocate more efforts towards individuals residing in socioeconomically deprived neighbourhoods is imminent. These individuals often face various health-related challenges and preventive research participation is not typically a priority for them. Additionally, they may lack awareness of existing preventive programmes, as for the CSPs.12, 46-49 It is essential, both for the well-being of individuals and the society as a whole, that screening-eligible individuals in lower SES-neighbourhoods actively participate in these programmes, also when taking the associated disease-related health costs into account.50, 51 The findings presented in Chapter 5 highlight the importance of exploring new invitation approaches to engage marginalized women in the CSPs. Then, concerning the policymakers of the Dutch College of General Practitioners (NHG; Nederlands Huisartsen Genootschap) a more definite stance when it comes to advising patients on their participation in the CSPs would be welcome. Despite years of thinking, reading, and researching the CSPs, it remains challenging to provide clear information and subsequent guidance on cancer screening participation. While the politically correct approach would be to leave the full decision with the individual, in reality this is not a fair option. Despite we are in the middle of the zeitgeist of shared decision making, 7
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