***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Despite the availability of multiple effective screening tests for colorectal cancer , screening rates remain suboptimal . The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening ( CRCS ) discussion s , but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary -care setting s. OBJECTIVE Describe  physician-patient CRCS discussion s during a wellness visit . DESIGN Cross-sectional ; patients audio-recorded with physicians . PARTICIPANTS A subset of patients ( N = 64 ) participating in a behavioral intervention trial design ed to increase CRCS who completed a wellness visit during the trial with a participating physician ( N = 8).APPROACHTranscripts were analyzed using qualitative methods . RESULTS Physicians in this sample consistently recommended CRCS , but focused on colonoscopy . Physicians did not offer a fecal occult blood test alone as a screening choice , which may have created missed opportunities for some patients to get screened . In this single visit , physicians ’ communication processes generally precluded discussion of patients ’ test preferences and did not facilitate shared decision-making . Patients ’ questions indicated their interest in different CRCS test types and appeared to elicit more information from physicians . Some patients remained resistant to CRCS after discussing it with a physician . CONCLUSION If a preference for colonoscopy is widespread among primary -care physicians , the implication s for intervention are either to prepare patients for this preference or to train physicians to offer options when recommending screening to patients Two methods of mass population screening for colorectal cancer - faecal occult blood testing and sigmoidoscopy - have been the subject of r and omized controlled trials in the UK . A national screening programme is currently under consideration and the choice of screening method remains open . To be successful , a programme will require high levels of uptake , and uptake is likely to depend upon subjects ' attitudes towards the screening method introduced . Although a preferred screening method has already been identified from a question naire survey , we undertook a further interview study ( n = 106 ) , with a view to comparing the results of two different approaches to eliciting public preferences . In comparison with the question naire study , a higher proportion of interview subjects stated a preference . Interview subjects were generally more favourably disposed towards sigmoidoscopy , excepting those with previous experience . Compared with the question naire survey , the interviews provided richer information on the reasons for preferences offered . Individual preferences were evidently subjective and dependant on attitudes towards a variety of method characteristics , such as discomfort , convenience and perceived sophistication . Characteristics such as age and low income , which had predicted preferences in the question naire study , predicted preferences in the interview study also . The difference between the results obtained by the different elicitation techniques can be explained in terms of the differential provision of information and sample selection . Conclusions made about public preferences are likely to depend on the technique employed in eliciting them Colorectal cancer is the second leading cause of cancer death in the United States.1 Appropriate screening can reduce incidence of and mortality from colorectal cancer.2–5 The US Preventive Services Task Force recommends that all average-risk individuals aged 50 years and older receive colorectal cancer screening.6 The American Cancer Society recommends several acceptable approaches to screening , including an annual 3-card home fecal occult blood test.7 The Healthy People 2010 objective is to increase the proportion of people aged 50 and older who have received a fecal occult blood test  within the preceding 2 years to at least 50%.8 Lack of knowledge , confidence , and skills ; negative attitudes toward the tests themselves ; fear of the consequences of screening ; and inadequate social support all have been suggested as possible barriers to colorectal cancer screening,9 whereas positive attitudes toward colorectal cancer screening and physician encouragement have been associated with receipt of a fecal occult blood test with a home stool kit.10 Despite these studies , gaps remain in what is known about barriers to successful interventions to increase  colorectal cancer screening  , particularly in minority population s.11,12 This study is based on the assumption that identification and definition of barriers to colorectal cancer screening in low-income , underserved minority population s can help guide the development of effective interventions Background Colorectal cancer screening ( CRCS ) is the only type of cancer screening where both genders reduce risks by similar proportions with identical procedures . It is an important context for examining gender differences in disease-prevention , as CRCS significantly reduces mortality via early detection and prevention . In efforts to increase screening adherence , there is increasing acknowledgment that obstructive attitudes prevent CRCS uptake . Precise identification of the gender differences in obstructive attitudes is necessary to improve uptake promotion . This study r and omly sample d unscreened , screening - eligible individuals in Ontario , employing semi-structured interviews to elicit key differences in attitudinal obstructions towards colorectal cancer screening with the aim of deriving informative differences useful in planning promotions of screening uptake . Methods N = 81 participants ( 49 females , 32 males ) , 50 years and above , with no prior CRCS , were contacted via r and om-digit telephone dialing , and consented via phone-mail contact . Altogether , N = 4,459 calls were made to yield N = 85 participants ( 1.9 % response rate ) of which N = 4 participants did not complete interviews . All subjects were eligible for free-of-charge CRCS in Ontario , and each was classified , via st and ard interview by CRCS screening decision-stage . Telephone-based , semi-structured interviews ( SSIs ) were employed to investigate gender differences in CRCS attitudes , using questions focused on 5 attitudinal domains : 1 ) Screening experience at the time of interview ; 2 ) Barriers to adherence ; 3 ) Predictors of Adherence ; 4 ) Pain-anxiety experiences related to CRCS ; 5 ) Gender-specific experiences re : CRCS , addressing all three modalities accessible through Ontario ’s program : a ) fecal occult blood testing ; b ) flexible sigmoidoscopy ; c ) colonoscopy . Results Interview transcript analyses indicated divergent themes related to CRCS for each gender : 1 ) bodily intrusion , 2 ) perforation anxiety , and 3 ) embarrassment for females and ; 1 ) avoidant procrastination with underlying fatalism , 2 ) unnecessary health care and 3 ) uncomfortable vulnerability for males . Respondents adopted similar attitudes towards fecal occult blood testing , flexible sigmoidoscopy and colonoscopy , and were comparable in decision stage across tests . Gender differences were neither closely tied to screening stage nor modality . Women had more consistent physician relationships , were more screening-knowledgeable and better able to articulate views on screening . Men reported less consistent physician relationships , were less knowledgeable and kept decision-making processes vague and emotionally distanced ( i.e. at ‘ arm ’s length ’ ) . Conclusions Marked differences were observed in obstructive CRCS attitudes per gender . Females articulated reservations about CRCS-associated distress and males suppressed negative views while ambiguously procrastinating about the task of completing screening . Future interventions could seek to reduce CRCS-related stress ( females ) and address the need to overcome procrastination ( males ) INTRODUCTION Uptake is an important determinant of the effectiveness of population -based screening . Uptake of colorectal cancer ( CRC ) screening generally remains sub-optimal . AIM To determine factors influencing the decision whether to participate or not among individuals invited for faecal occult blood test ( FOBT ) or flexible sigmoidoscopy ( FS ) screening .  METHODS A question naire was sent to a stratified r and om sample of individuals aged 50 - 74 , previously invited for a r and omised CRC screening trial offering FOBT or FS , and a reference group from the same population not previously invited ( screening naïve group ) . The question naire assessed reasons for (non)-participation , individuals ' characteristics associated with participation , knowledge , attitudes and level of informed choice . RESULTS The  response rate was 75 % ( n=341/452 ) for CRC screening participants , 21 % ( n=676/3212 ) for non- participants and 38 % ( n=192/500 ) for screening-naïve individuals . The main reasons for FOBT and FS participation were acquiring certainty about CRC presence and possible early CRC detection . Anticipated regret and positive attitudes towards CRC screening were strong predictors of actual participation and intention to participate in a next round . The main reason for non-participation in FOBT screening was lack of abdominal complaints . Non-participation in FS screening was additionally influenced by worries about burden . Eighty-one percent of participants and 12 % of non- participants made an informed choice on participation . CONCLUSION Only 12 % of non- participants made an informed choice not to participate . These results imply that governments and /or organizations offering screening should focus on adequately informing and educating target population s about the harms and benefits of CRC screening . This may impact uptake of CRC screening While a wide range of behavioral and psychosocial literature explores attitudes and beliefs towards cancer screenings , fewer studies examine attitudes across cancer screening types . We draw on quantitative and qualitative findings from a 4-year prospect i ve study based at a community health center serving diverse , low-income patients . Methods included  self-report surveys ( n = 297 ) , medical chart abstract ion , and several qualitative methods with a sub sample of participants . Participants included white , African – American , Vietnamese , and Latino patients who were diagnosed with diabetes , hypertension , or both .  Patients ’ attitudes ( both positive and negative ) towards cancer screening types were remarkably consistent across cancer screening types . These effects were stronger among men than women . Never having had a cancer screening was generally associated with more unfavorable attitudes towards all screenings . Qualitative interviews indicate the importance of information circulated through social networks in shaping attitudes towards cancer screenings . Condensed abstract : In a multi- method study of attitudes towards cancer screening  among medically underserved patients in a primary care setting , we found that attitudes ( both positive and negative ) were remarkably consistent across cancer screening types OBJECTIVE To identify barriers and facilitators associated with participation in the first round of a  population -based program for colorectal cancer ( CRC ) in Catalonia , Spain and to identify strategies for motivating and supporting behavioral change . MATERIAL AND METHODS A two-part , mixed- methods design was used . In first place , a prospect i ve study of individuals aged 50 - 69 years ( n=1961 ) was conducted in 2006 - 2007 . Secondly , focus groups were undertaken with participants and non- participants of the CRC screening , in 2008 . RESULTS Intention to participate was an important determinant of participation ( 82.9 % vs 65.9 % , OR=2.56 , 95%CI:1.95 - 3.36 ) in addition to knowledge about CRC and its early detection . Respondents who reported that CRC may be asymptomatic in early stages enrolled in the screening program more frequently than those who thought CRC is always symptomatic ( 49.4 % vs 44.8 % , OR:1.82 ; 95%CI:1.3 - 2.6 ) . Barriers for participation mentioned in focus groups were competing perceived for other health problems and other dem and s as well as misunderst and ing about personal relevance of the screening . CONCLUSION Individuals ' perceptions of CRC are amenable to change through education-based interventions . Increasing public knowledge related to the burden of CRC and its preventive potential may be an effective way for improving participation in a population -based screening program Objectives To assess the acceptability of bowel cancer screening using flexible sigmoidoscopy ( FS ) . Setting Adults aged 55 to 64 recruited from general practice s in Welwyn Garden City and Leicester , which were the pilot and start up centres of a multicentred r and omised controlled trial of FS screening ( the ICRF/MRC Flexible Sigmoidoscopy Screening Trial ) . Methods Screenees ( n=4422 ) were sent a three month follow up question naire that included measures of satisfaction with information given before the test , facilities at the test unit , attitudes of the staff , and explanation of the results . Measures of pain , embarrassment , feelings of being “ in control ” during the test , willingness to encourage others to have the test , and gladness to have participated were also included . In addition , semistructured telephone interviews were conducted with 60 screenees , stratified by screening outcome and gender . Results The follow up question naire was completed by 94 % of screenees . Responses indicated a high level of satisfaction with the procedure : 99 % were satisfied with the information given before the test , the facilities , the attitudes of the staff , and the explanation of their results ; 91 % reported only mild or no pain ; 97 % reported little or no embarrassment ; and 99 % were glad they had the test . Satisfaction ratings varied little by gender or outcome group . The quantitative results were reinforced by the qualitative data , which also revealed high acceptability . Conclusion In the context of a clinical trial with dedicated trial staff , FS is a well tolerated procedure . There are high levels of satisfaction with service provision and positive attitudes towards the programme 
    Output:
    
The decision to participate in colorectal cancer screening depended on an individual 's awareness of colorectal cancer screening .
Awareness affected views of cancer , attitudes towards colorectal cancer screening modalities , and motivation for screening .
Factors mediating awareness included public education to address misconceptions , primary care physician efforts to recommend screening , and the influence of friends and family .
Specific barriers to participation in population s with lower participation rates included language barriers , logistical challenges to attending screening tests , and cultural beliefs .