Acceptability of risk-tailored cancer screening among Australian GPs: a qualitative study

Abstract

Background: Cancer screening that is tailored to individual risk has the potential to improve health outcomes and reduce screening-related harms, if implemented well. However, successful implementation depends on acceptability, particularly as this approach will require general practitioners (GPs) to change their practice. Aim: To explore Australian GPs’ views about the acceptability of risk-tailored screening across cancer types and identify barriers and facilitators to implementation. Design and Setting: Qualitative design using semi-structured interviews with 20 Australian GPs. Method: Interviews were audio recorded and transcribed. Data were first analysed inductively then deductively using an implementation framework. Results: Participants found risk-tailored screening to be acceptable in principle, recognising potential benefits in offering enhanced screening to those at highest risk. However, they had significant concerns that changes in screening advice could potentially cause confusion. They also reported that a reduced screening frequency or exclusion from a screening program for those deemed low risk may not initially be acceptable, especially for common cancers with minimally invasive screening. Other reservations about implementing risk-tailored screening in general practice included: the lack of high-quality evidence of benefit, fear of missing the signs or symptoms of a patient’s cancer, and inadequate time with patients. While no single preferred approach to professional education was identified, education around communicating screening results and risk stratification was considered important. Conclusion: GPs may not be currently convinced of the net benefits of risk-tailored screening. Development of accessible evidence-based guidelines, professional education, risk calculators and targeted public messages will increase its feasibility in general practice.