Engagement of General Practice in an Australian Organised Bowel Cancer Screening Program: A Cross-Sectional Survey of Knowledge and Practice

Knowledge, attitude, and practice of healthcare workers on early gastrointestinal cancer in China

Objective

Gastrointestinal cancer is the leading cause of cancer-related death in China, and its early screening is largely recommended by healthcare workers. This study investigated the knowledge, attitudes, and practice (KAP) of healthcare workers on early gastrointestinal cancer (EGC).

Methods

This cross-sectional study was conducted on healthcare workers who volunteered to participate from 30 hospitals in China between September and December 2022. A self-administered questionnaire including 37 questions was developed.

Results

A total of 545 completed questionnaires were finally obtained. Healthcare workers had moderate knowledge level [9.22 ± 1.80 (65.88±12.89%), total score: 14], positive attitude [21.84 ± 2.67 (91.01 ± 11.14%), total score: 24], and excellent practice level [19.07 ± 4.43 (79.47 ± 18.44%), total score: 24] on EGC. Pearson's correlation analysis suggested that knowledge score was positively correlated with attitude (r = 0.264, P < 0.001) and practice score (r = 0.140, P = 0.001), and higher attitude score was significantly correlated with higher practice score (r = 0.380, P < 0.001), which were supported and reinforced by structural equation modeling. In addition, subgroup analysis showed that knowledge scores might be influenced by sex, age, education, type of hospital, type of occupation, professional title, and years of working (all P < 0.05); attitude scores might be influenced by years of working (P < 0.05); and practice scores were statistically distinct among groups of different sex, department, and years of working (all P < 0.05).

Conclusion

Healthcare workers have moderate knowledge level, positive attitude, and excellent practice levels on EGC. Good knowledge and positive attitude might be correlated with excellent practice. KAP level might be influenced by sociodemographic characteristics.

Age-related experiences of colorectal cancer diagnosis: a secondary analysis of the English National Cancer Patient Experience Survey

OBJECTIVE

The incidence of colorectal cancer (CRC) in people aged <50 years has been increasing dramatically in the past three decades and such patients are known to face difficulties in diagnosis. The objective of this study was to better understand the diagnostic experiences of patients with CRC and explore age-related differences in the proportion with positive experiences.

METHOD

A secondary analysis of the English National Cancer Patient Experience Survey (CPES) 2017 was conducted on the responses of patients with CRC, restricted to those likely to have been diagnosed in the preceding 12 months via pathways other than routine screening. Ten diagnosis-related experience questions were identified, with responses to them categorised as positive, negative or uninformative. Age group-related difference in positive experiences were described and ORs estimated, both raw and adjusted for selected characteristics. Sensitivity analysis was performed by weighting survey responses to 2017 cancer registrations by strata defined by age group, sex and cancer site, to assess whether differential response patterns by these characteristics affected the estimated proportion of positive experiences.

RESULTS

The reported experiences of 3889 patients with CRC were analysed. There was a significant linear trend (p<0.0001) for 9 of 10 experience items, with older patients consistently displaying higher rates of positive experiences and patients aged 55-64 showing rates of positive experience intermediate between younger and older age groups. This was unaffected by differences in patient characteristics or CPES response rates.

CONCLUSION

The highest rates of positive diagnosis-related experiences were reported by patients aged 65-74 or 75 years and older, and this is robust.

Health care system factors influencing primary healthcare workers' engagement in national cancer screening programs: a qualitative study

OBJECTIVE

This study aimed to explore factors across the environment, organisation and care team levels of the health care system that influence the engagement of primary healthcare workers (PHCWs) in Australia's national cancer screening programs.

METHODS

A cross-sectional qualitative study involving semi-structured interviews with PHCWs - general practitioners (n=10), practices nurses (n=10), and practice managers (n=10) from settings across Australia. Transcripts were analysed using the Framework Method.

RESULTS

Two environment-level factors were found to influence several organisation and care team level factors. Firstly, the financial structure of primary health care, impacting on practitioner: time, practice culture, screening knowledge and opportunistic conversations. Secondly, the structure of screening programs had flow-on effects for: access to patient screening records, recall and reminder systems, and sense of program ownership.

CONCLUSIONS

Encouraging more effective PHCW engagement in the screening programs requires the consideration and mitigation of overarching financial and structural barriers. Up-to-date and easy-to-use recall and reminder systems, whole-of-practice approaches which optimise the role of each PHCW and the identification of a 'champion' to drive implementation should be considered.

IMPLICATIONS FOR PUBLIC HEALTH

This study offers insights into what elements practice and practitioner targeted initiatives in Australia should incorporate, potentially leading to improved engagement of PHCWs and increased cancer screening participation rates.