Thom Bongaerts

207 Summary this was the concept of an ‘add-on methodology’, whereby GPs/general practices themselves selectively invite patients, as a supplement to the general invitation for participation in the CSPs. The most positive effects are likely to be expected when GPs select patients whom they assess to be at (higher) risk of developing one of the screeningspecific tumours. Conclusion The studies described in this thesis provide additional evidence that the current Dutch population-based screening programmes (CSPs) can be further optimized, particularly concerning the participation of potential participants from highly urbanized and low socioeconomic status (SES) neighbourhoods. Our findings suggest that non-participation in the CSPs in these low SES-neighbourhoods is associated with more unfavourable, relatively advanced, tumour outcomes. Given that the decision to participate in a CSP is not solely based on rational decision-making processes, primary care providers could play an important role here. This would primarily involve informing and advising potential participants who are hesitant about participating in CSPs. In this thesis, we describe that both potential participants and general practitioners support the idea that primary care should be more involved in the invitation process of the CSPs. Based on our findings, we therefore recommend implementing a proactive, risk-based invitation strategy from primary care regarding the invitation process of the current CSPs. 8

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