Defensiveness may help explain limited uptake of FIT, Irish study finds

Patients who declined an invitation to fecal immunochemical testing (FIT) scored higher on a measure of defensive information processing, indicating that certain psychological approaches may be more likely to increase screening uptake.

A defensive way of processing information can help explain why more patients don't undergo fecal immunochemical testing (FIT) for colorectal cancer, a recent study found.

Researchers in Ireland surveyed 7,476 Dublin residents who had been invited to participate in FIT (3,738 who declined and a matched number who underwent FIT); they received responses from 1,988 patients who completed FIT and 311 who didn't. The surveys assessed whether defensive information processing (DIP) was associated with FIT use. DIP is a means by which individuals reduce negative psychological affect when faced with real or imagined threats (e.g., cancer). The DIP measure contained seven subscales: 1) opt-out informational (e.g., “I avoid watching TV programs about cancer”), 2) opt-out behavioral (e.g., “I don't go to a doctor unless it's really serious”), 3) blunting (e.g., “I tend to avoid thoughts of bowel cancer”), 4) suppression (e.g., “I will wait to get tested for bowel cancer when I am not as busy”), 5) suppression/self-exemption (e.g., “I don't need to be screened for bowel cancer because I have regular bowel movements”), 6) counterarguing/message rejection (“Few people get bowel cancer”), and 7) counterarguing/normalizing risk (“I can't do everything that you're supposed to do for your health; it'd be a full time job”). Results were published by Cancer on Feb. 6.

After adjustment for sociodemographic factors, higher scores (equating to greater defensiveness) on all DIP domains were significantly associated with lower FIT uptake. When the results were also adjusted for behavioral factors, only the suppression subdomains of “deny immediacy to be tested” and “self-exemption” independently predicted which patients would not complete FIT. “This has implications for the development and targeting of interventions to improve screening uptake. For example, future invitations could specifically target suppression beliefs to determine whether undermining one and/or both is sufficient to increase screening uptake or change the pattern of results observed in this study,” the study authors said. They suggested that messages encouraging patients to undergo FIT create a sense of urgency, highlighting the often-asymptomatic nature of colorectal cancer. “Providing colorectal cancer risk estimates to promote screening is not advised unless strategies are in place to curb defensiveness, especially among higher risk groups,” they wrote.

An accompanying editorial discussed techniques for dealing with these barriers and getting patients to engage in cancer screening or other interventions such as COVID-19 vaccination. “Overcoming DIP by self-exemption or by counterarguing by rejecting messages or normalizing risk might require different strategies, such as outreach or communications by trusted peers, clinicians, or community health workers,” it said. “The three C's—compassionate understanding, connection, and collaboration—provide guiding principles for addressing misinformation and moving patients toward evidence-based health-protective behaviors and actions.”