Colorectal cancer screening awareness in European primary care

Nationwide Epidemiological Study of Knowledge, Attitudes, and Practices Study of Greek General Practitioners Related to Screening

Background:

We aimed to assess general practitioners’ (GPs) knowledge, attitudes, and practices (KAPs) toward screening recommendation guidelines of the United States Preventive Services Task Force (USPSTF).

Methods:

The survey was conducted during a 6-month period in a stratified random sample of GPs, drawn from a national database of GPs in Greece. Participants were queried about their knowledge, attitudes, and self-reported practice patterns regarding screening in a primary care setting. Sociodemographic characteristics associated with vague screening practicing were identified using multivariable logistic regression models.

Results:

A total of 299 participants agreed and underwent telephonic survey (response rate: 78.2%). GPs agreed on the key role of population-based screening in improving patient care, and nine out of ten reported that their performance would be improved with the adoption of computer-based support systems in clinical practice. GPs, older than 50 years of age, those who those practicing for more than 15 years and GPs working in private sector, were less likely to comply with screening recommendations. Latent class analysis revealed that male physicians and those working in public sector were more likely to comply with USPSTF recommendations.

Conclusions:

Our findings highlight the need of educational intervention programs for GPs in order to promote the implementation of national evidence-based screening recommendation statements in clinical practice.

Screening for colorectal cancer: the role of the primary care physician

In recent years, the role of primary care physicians (PCPs) in the diagnosis and management of gastrointestinal disorders, including screening for colorectal cancer (CRC), has been recognized as very important. The available data indicate that PCPs are not adequately following CRC screening guidelines because a number of factors have been identified as significant barriers to the proper application of CRC screening guidelines. These factors include lack of time, patient reluctance, and challenges related to scheduling colonoscopy. Further positive engagement of PCPs with CRC screening is required to overcome these barriers and reach acceptable levels in screening rates. To meet the expectations of modern medicine, PCPs should not only be able to recommend occult blood testing or colonoscopy but also, under certain conditions, able to perform colonoscopy. In this review, the authors aim to provide the current knowledge of the role of PCPs in increasing the rate and successfully implementing a screening program for CRC by applying the relevant international guidelines.

Management of Gastrointestinal Disorders in Central and Eastern Europe: Self-Reported Practice of Primary Care Physicians

Background

Gastrointestinal disorders account for 7–10% of all consultations in primary care. General practitioners’ management of digestive disorders in Central and Eastern European countries is largely unknown.

Aims

To identify and compare variations in the self-perceived responsibilities of general practitioners in the management of digestive disorders in Central and Eastern Europe.

Methods

A cross-sectional survey of a randomized sample of primary care physicians from 9 countries was conducted. An anonymous questionnaire was sent via post to primary care doctors.

Results

We received 867 responses; the response rate was 28.9%. Over 70% of respondents reported familiarity with available guidelines for gastrointestinal diseases. For uninvestigated dyspepsia in patients under 45 years, the “test and treat” strategy was twice as popular as “test and scope”. The majority (59.8%) of family physicians would refer patients with rectal bleeding without alarm symptoms to a specialist (from 7.6% of doctors in Slovenia to 85.1% of doctors in Bulgaria; p<0.001). 93.4% of respondents declared their involvement in colorectal cancer screening. In the majority of countries, responding doctors most often reported that they order fecal occult blood tests. The exceptions were Estonia and Hungary, where the majority of family physicians referred patients to a specialist (p<0.001).

Conclusions

Physicians from Central and Eastern European countries understood the need for the use of guidelines for the care of patients with gastrointestinal problems, but there is broad variation between countries in their management. Numerous efforts should be undertaken to establish and implement international standards for digestive disorders’ management in general practice.

Knowledge, Attitude, Practice, and Perceived Barriers of Colorectal Cancer Screening among Family Physicians in National Guard Health Affairs, Riyadh

Objectives. The objective of this study is to explore the current knowledge, attitude, and practice of family physicians working in family medicine clinics in National Guard Health Affairs (NGHA), Riyadh, toward colorectal cancer (CRC) screening and to identify the barriers of the screening. Methods. Data were collected using a validated self-administered questionnaire adopted from the National Cancer Institute in USA, customized by adding and eliminating questions to be in line with the institution (NGHA) characteristics. Results. Of the 130 physicians, 56.2% of the physicians were not practicing CRC screening although 94.6% considered CRC screening effective. Board certified physicians had higher knowledge score and were practicing CRC screening more when compared to other physicians. Physicians who reported practicing CRC screening scored more on the knowledge score than those not practicing. Male physicians scored better on attitude score than female physicians. The study found that barriers were cited in higher rates among physicians not practicing CRC screening compared with practicing physicians. Lack of patients' awareness was the most cited barrier. Conclusion. Large percentage of family physicians in this study do not practice CRC screening, despite the knowledge level and the positive attitude.

The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases

Chronic gastrointestinal disorders are a source of substantial morbidity, mortality, and cost. They are common in general practice, and the primary care physician (PCP) has a central role in the early detection and management of these problems. The need to make cost-effective diagnostic and treatment decisions, avoid unnecessary investigation and referral, provide long-term effective control of symptoms, and minimize the risk of complications constitute the main challenges that PCPs face. The literature review shows that, although best practice standards are available, a considerable number of PCPs do not routinely follow them. Low rates of colorectal cancer screening, suboptimal testing and treatment of Helicobacter pylori infection, inappropriate use of proton pump inhibitors, and the fact that most PCPs are still approaching the irritable bowel disease as a diagnosis of exclusion represent the main gaps between evidence-based guidelines and clinical practice. This manuscript points out that updating of knowledge and skills of PCPs via continuing medical education is the only way for better adherence with standards and improving quality of care for patients with gastrointestinal diseases.

Colocteral cancer management and prevention policies in Greece

Despite lower cancer mortality rates in Greece compared to other European countries, colorectal cancer (CRC) is the third most important cause of cancer mortality. Given the significant economic and societal impact of CRC in Greece, this paper focuses on CRC data resources, disease management and the existing prevention policies. Numerous initiatives have taken place for the collection of data and the creation of cancer registries, however, they currently remain incomplete. Despite universal access of the Greek population to health services provision, structural problems of the national health system have imposed organisational barriers to the geographical distribution of health resources. National invitational CRC screening programmes focusing on early detection of the disease as well as guidelines for its management are missing. All novel cancer treatments are fully reimbursed. Post-treatment surveillance guidelines for high-risk patients are very limited and depend solely on health providers' decisions. A National Cancer Plan (NCP) had been announced during the 2008-2012, but is still in the planning phases. Under the proposed NCP, the longevity of cancer data collection seems to be the critical step in monitoring and improving the performance of the health system. Detailed epidemiological data will give the possibility of constructing an effective prevention policy, will reduce socio-economic inequalities in the access to CRC treatment and lighten the differences observed in health outcomes. The full implementation of the NCP constitutes the most significant investment in cancer management that has ever taken place in Greece.

Cancer screening in Greece. Guideline awareness and prescription behavior among Hellenic physicians

BACKGROUND

Primary cancer prevention is offered by the Greek health care system to the population on an opportunistic basis. This means that screening depends on advice from primary care providers and on individuals' request for screening, since a centralized invitational register is lacking. In planning preventive services, an accurate identification of baseline levels of performance for preventive activities is fundamental, so that realistic goals can be set.

METHODS

366 primary care physicians (39.3% response rate) from nine Greek provinces were surveyed by means of a self-reporting questionnaire of prescription habits. Physicians' screening behaviors and screening recommendations were analyzed for both cost-effective and non-recommended tests during usual check-up visits and targeted cancer screening activities were analyzed.

RESULTS

A wide variety of recommendation habits were observed among primary care physicians. With the exception of PAP test, cost-effective tests were advised at sub-optimal rates, with colorectal cancer screening being much less than desirable. Moreover, non-recommended tests were frequently advised.

CONCLUSION

Screening tests are performed sporadically and an overall understanding of primary care prevention is lacking. More focused educational interventions must be implemented if primary care is to make an impact on cancer mortality.

Can colorectal cancer mass-screening organization be evidence-based? Lessons from failures: the experimental and pilot phases of the Lazio program

Background

Screening programmes should be organized to translate theoretical efficacy into effectiveness. An evidence-based organizational model of colorectal cancer screening (CRCS) should assure feasibility and high compliance.

Methods

A multidisciplinary Working Group (WG), reviewed literature and guidelines to define evidence-based recommendations. The WG identified the need for further local studies: physicians' CRCS attitudes, the effect of test type and provider on compliance, and individual reasons for non-compliance. A survey of digestive endoscopy services was conducted. A feasibility study on a target population of 300.000 has begun.

Results

Based on the results of population trials and on literature review the screening strategy adopted was Faecal Occult Blood Test (FOBT) every two years for 50–74 year olds and, for positives, colonoscopy. The immunochemical test was chosen because it has 20% higher compliance than the Guaiac. GPs were chosen as the preferred provider also for higher compliance. Since we observed that distance is the major determinant of non-compliance, we choose GPs because they are the closest providers, both geographically and emotionally, to the public.

The feasibility study showed several barriers: GP participation was low, there were administrative problems to involve GPs; opportunistic testing by the GPs; difficulties in access to Gastroenterology centres; difficulties in gathering colonoscopy results; little time given to screening activity by the gastroenterology centre.

Conclusion

The feasibility study highlighted several limits of the model. Most of the barriers that emerged were consequences of organisational choices not supported by evidence. The principal limit was a lack of accountability by the participating centres.

Colorectal cancer screening coverage in Greece. PACMeR 02.01 study collaboration

BACKGROUND AND AIMS

Colorectal cancer is a major cause of cancer death in European countries and differences in screening implementation may in part explain USA vs European survival differences. Despite the evidence, no study has evaluated the population colorectal cancer screening (CCS) coverage in any European country. We aimed to index the current CCS practices among a large sample of Greek healthy adults.

MATERIALS AND METHODS

The study was designed as a cross-sectional survey. Screening practice habits of 5,259 healthy adults, aged 50-80, were surveyed. Both overall and screening practices of stool occult blood test (SOBT), digital rectal examination (DRE), and colonoscopy or sigmoidoscopy (COL/SIG) were analyzed.

RESULTS

Of the population analyzed, 90.1% declared that they were interested in cancer prevention activities. Overall SOBT practice rate within the last 2 years was 4.77%. When only screening procedures were analyzed, this percentage shrank to 1.73%. Overall and screening COL/SIG rates within the last 10 years were 8.76 and 1.74%, respectively. The respective proportions of individuals who underwent DRE were 14.54 and 5.2%. Evidence-based screening practices were influenced by age, family history of colorectal cancer, profession, and educational level; however, SOBT and colonoscopy/sigmoidoscopy did not overcome 4.1 and 4.6% in any subpopulation analyzed.

CONCLUSION

The level of CCS coverage among the examined sample of Greek adults was discouraging. Surveys among other European countries are encouraged.

Colorectal cancer screening awareness among physicians in Greece

BACKGROUND

Data comparison between SEER and EUROCARE database provided evidence that colorectal cancer survival in USA is higher than in European countries. Since adjustment for stage at diagnosis markedly reduces the survival differences, a screening bias was hypothesized. Considering the important role of primary care in screening activities, the purpose of the study was to investigate the colorectal cancer screening awareness among Hellenic physicians.

METHODS

211 primary care physicians were surveyed by mean of a self-reported prescription-habits questionnaire. Both physicians' colorectal cancer screening behaviors and colorectal cancer screening recommendations during usual check-up visits were analyzed.

RESULTS

Only 50% of physicians were found to recommend screening for colorectal cancer during usual check-up visits, and only 25% prescribed cost-effective procedures. The percentage of physicians recommending stool occult blood test and sigmoidoscopy was 24% and 4% respectively. Only 48% and 23% of physicians recognized a cancer screening value for stool occult blood test and sigmoidoscopy. Colorectal screening recommendations were statistically lower among physicians aged 30 or less (p = 0.012). No differences were found when gender, level and type of specialization were analyzed, even though specialists in general practice showed a trend for better prescription (p = 0.054).

CONCLUSION

Contemporary recommendations for colorectal cancer screening are not followed by implementation in primary care setting. Education on presymptomatic control and screening practice monitoring are required if primary care is to make a major impact on colorectal cancer mortality.