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Reasons for intending to accept or decline kidney cancer screening: thematic analysis of free text from an online survey

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Freer-Smith, Charlotte 
Harvey-Kelly, Laragh 
Mills, Katie 
Harrison, Hannah 
Rossi, Sabrina H 


Objectives: Kidney cancer has been identified as a disease for which screening might provide significant benefit for patients. The aim of this study was to understand in detail the facilitators and barriers towards uptake of a future kidney cancer screening programme, and to compare these across four proposed screening modalities. Design: An online survey including free-text responses. Setting: UK Participants: 668 adults Primary and secondary outcome measures: The survey assessed participants’ self-reported intention to take-up kidney cancer screening with four different test methods (urine test, blood test, ultrasound scan and low-dose CT). We conducted thematic analysis of 2559 free-text comments made within the survey using an inductive approach. Results: We identified five overarching themes that influenced screening intention: ‘personal health beliefs’, ‘practicalities’, ‘opinions of the test’, ‘attitudes towards screening’ and ‘cancer apprehension’. Overall, participants considered the tests presented as simple to complete and the benefits of early detection to outweigh any drawbacks to screening. Dominant facilitators and barriers varied with patterns of intention to take up screening across the four tests. Most intended to take up screening by all four tests, and for these participants, screening was seen as a positive health behaviour. A significant minority were driven by practicalities and the risks of the tests offered. A smaller proportion intended to reject all forms of screening offered, often due to fear or worry about results and unnecessary medical intervention or a general negative view of screening. Conclusions: Most individuals would accept kidney cancer screening by any of the four test options presented because of strong positive attitudes towards screening in general and the perceived simplicity of the tests. Providing information about the rationale for screening in general and the potential benefits of early detection will be important to optimise uptake among uncertain individuals.



Public health, 1506, 1724, kidney tumours, preventive medicine, public health, qualitative research

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BMJ Open

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BMJ Publishing Group
The Urology Foundation (Not applicable)
Renal Cancer Research Fund (Not applicable)
Cancer Research UK (C55650/A21464, Major Centre Award A25117)
Research Trainees Coordinating Centre (RM-SR-2017-09-009)
Kidney Cancer UK (Not applicable)