International Journal of Colorectal Disease

, Volume 32, Issue 7, pp 1065–1068 | Cite as

Getting the first degree relatives to screen for colorectal cancer is harder than it seems—patients’ and their first degree relatives’ perspectives

  • Ker-Kan Tan
  • Tian-Zhi Lim
  • Dedrick Kok Hong Chan
  • Emily Chew
  • Wen-Min Chow
  • Nan Luo
  • Mee-Lian Wong
  • Gerald Choon-Huat Koh
Short Communication



First degree relatives (FDR) of colorectal cancer (CRC) patients are at increased risk of CRC compared to the general population. However, screening colonoscopy rates amongst the FDRs remain dismal. The aim of the study was to explore the various issues amongst the patients and their FDR precluding their adoption of screening colonoscopy.


A qualitative study of CRC patients and their FDRs was performed. Semi-structured interviews were conducted with participants using open-ended questions until data saturation was achieved. These qualitative data were then thematically analysed.


Fifty CRC patients and thirty-one FDRs were recruited between June 2015 and December 2015. For the patients, three main themes emerged, which include (i) poor understanding of the CRC screening guidelines for their FDRs, (ii) recommendations are lacking amongst medical professionals and (iii) numerous barriers are hindering patients from being advocates for screening colonoscopy for their FDRs. For the FDRs, three main themes emerged. These include (i) poor understanding of the exact CRC screening guidelines amongst the FDRs, (ii) the lack of health promotion efforts amongst medical professionals and (iii) barriers to the uptake of screening colonoscopy such as fear of colonoscopy, high cost of the procedure, its associated inconvenience and perceived invulnerability of the individual.


Patients and FDRs are not aware of the increased risks of developing CRC amongst the family members. Guidelines regarding screening are also not clearly understood. The numerous barriers that are present amongst the CRC patients and their FDRs can be addressed.


First degree relatives Colorectal cancer Barriers Screening Qualitative interviews 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Financial support

Supported by the Start Up Fund from Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Supplementary material

384_2017_2818_MOESM1_ESM.docx (14 kb)
Supplementary File 1 Details of Methodology (DOCX 14 kb)
384_2017_2818_MOESM2_ESM.docx (19 kb)
Supplementary File 2 Excerpts of transcripts pertinent to the themes. (DOCX 19 kb)


  1. 1.
    (1994) A prospective study of family history and the risk of colorectal cancer. N Engl J Med 331:1669–74Google Scholar
  2. 2.
    Samadder NJ, Curtin K, Tuohy TM, Rowe KG, Mineau GP, Smith KR, Pimentel R, Wong J, Boucher K, Burt RW (2014) Increased risk of colorectal neoplasia among family members of patients with colorectal cancer: a population-based study in Utah. Gastroenterology 147(4):814–821CrossRefPubMedGoogle Scholar
  3. 3.
    Tuohy TM, Rowe KG, Mineau GP, Pimentel R, Burt RW, Samadder NJ (2014) Risk of colorectal cancer and adenomas in the families of patients with adenomas: a population-based study in Utah. Cancer 120(1):35–42CrossRefPubMedGoogle Scholar
  4. 4.
    Carnevale FA (2002) Authentic qualitative research and the quest for methodological rigour. Can J Nurs Res Sep 34(2):121–128Google Scholar
  5. 5.
    Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101CrossRefGoogle Scholar
  6. 6.
    Fenton JJ, Jerant AF, von Friederichs-Fitzwater MM, Tancredi DJ, Franks P (2011) Physician counseling for colorectal cancer screening: impact on patient attitudes, beliefs, and behavior. J Am Board Fam Med 24(6):673–681CrossRefPubMedGoogle Scholar
  7. 7.
    Chua AH, Koh GC (2014) Does patient education and recommendation result in increased uptake of colorectal cancer screening using the fecal occult blood test? Ann Acad Med Singap 43(10):517–518PubMedGoogle Scholar
  8. 8.
    Quintero E, Carrillo M, Gimeno-García AZ, Hernández-Guerra M, Nicolás-Pérez D, Alonso-Abreu I, Díez-Fuentes ML, Abraira V (2014) Equivalency of fecal immunochemical tests and colonoscopy in familial colorectal cancer screening. Gastroenterology 147(5):1021–1030CrossRefPubMedGoogle Scholar
  9. 9.
    van Dijk DA, Oostindiër MJ, Kloosterman-Boele WM, Krijnen P, Vasen HF (2007) Hereditary tumor study Group of the Comprehensive Cancer Centre West. Family history is neglected in the work-up of patients with colorectal cancer: a quality assessment using cancer registry data. Familial Cancer 6(1):131–134CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Division of Colorectal Surgery, University Surgical ClusterNational University Health SystemSingaporeSingapore
  2. 2.Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  3. 3.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore

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