Designing an Effective Colorectal Cancer Screening Program in Egypt: A Qualitative Study of Perceptions of Egyptian Primary Care Physicians and Specialists

Abstract

Background. In Egypt more than one-third of colorectal cancer (CRC) cases occur in individuals aged 40 years and younger, and are diagnosed at advanced stages; currently, CRC screening is not done as a routine part of preventive care. To lay the foundation for the development of a CRC multilevel screening program in Egypt, this qualitative study aimed to explore the perspectives of Egyptian physicians. Materials and Methods. The PRECEDE-PROCEED model, which focuses on predisposing (intrapersonal), reinforcing (interpersonal), and enabling (structural) factors inherent in health behaviors, served as our theoretical framework. Primary health care physicians, oncologists, and gastroenterologists practicing in Alexandria, Egypt, participated in 1 one-hour semistructured interview. Interviews were audio recorded, transcribed, translated into English, and analyzed by thematic analysis. Results. Seventeen physicians participated (n = 8 specialists and n = 9 primary care physicians). Barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention, fear, and cost (predisposing); a belief that only high risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately (reinforcing); and cost, lack of availability of the tests, and inadequate training for laboratory technicians and providers (enabling). Potential facilitators included implementing a media campaign emphasizing early detection, curability and prevention (predisposing); educating physicians and eliciting physician engagement (reinforcing); and decreasing costs, making screening tests widely available, and providing well-trained providers (enabling). Conclusion. A CRC screening program is needed in Egypt, and to be successful it would likely need to address barriers at multiple levels. The Oncologist 2020;25:e1525-e1531 Implications for Practice: In Egypt, colorectal screening is not a routine part of preventive care, and colorectal cancer is often diagnosed at an advanced stage in individuals aged 40 years or younger. Screening can prevent and detect colorectal cancer in its early stages, but before designing any screening program, understanding the context is important as cultural beliefs may impact the acceptability of screening methods. By exploring the perspectives of Egyptian physicians, this study found important insights into how screening program components should be considered in the Egyptian culture and lays the foundation for the development of a multilevel colorectal screening program in Egypt.

Using Intervention Mapping to Develop a Theory-Based Intervention to Promote Colorectal Cancer Screening in Egypt

“…Step 1: Needs assessment Our assessment began with a literature review of CRC screening programs in Egypt and other Middle Eastern countries, followed by seven focus groups of residents in Alexandria (N = 61), conducted at clinic sites, and 17 one-on-one interviews with primary care physicians, gastroenterologists, and oncologists, conducted at clinics and workplace offices (Bateman et al, 2020). Interview participants were recruited within the Alexandria University primary care and specialty clinics and focus group participants were approached at clinics, specialty care clinics, and social clubs by researchers attending the events for the purpose of recruitment.…”

“…In addition, they felt that barriers were multilevel and required a multilevel response in order to successfully lower morbidity and mortality of CRC. Some suggestions included providing screening tests at no or low cost, making tests widely available, and creating a nationwide media campaign to educate the public regarding prevention and early detection that highlights younger-age prevalence (Bateman et al, 2020). hour.…”

“…Findings from the one-on-one physician and specialist interviews (Bateman et al, 2020) Abbreviations: MD, data from physician interviews; FG, data from focus groups…”

“…Figure 1 describes our intervention mapping steps. Beginning with Step 1, we completed a needs assessment, which included a literature review to identify research on CRC screening interventions in Egypt, focus groups with residents in Alexandria to identify barriers and facilitators to CRC information and screening, and one-on-one interviews with primary care physicians, gastroenterologists, and oncologists to determine their awareness of CRC screening recommendations and to identify barriers they experienced in patient care as well as assets already in place (Bateman et al, 2020). The question guides were provided by the authors to the interviewers and moderators prior to the actual interviews and focus groups after testing the components to assess appropriateness.…”

Circulating Cell Free DNA Integrity Index as a Biomarker for Response to Chemotherapy in Patients with Metastatic Colorectal Carcinoma

“…Colorectal cancer (CRC) ranks as the third most common cancer globally and second in terms of mortality (Bray et al, 2018;Ferlay et al, 2018). In Egypt, CRC has been detected in 13% of patients undergoing colonoscopy, and the incidence is increasing annually with more than one-third of the cases are individuals aged 40 years and younger often diagnosed at an advanced stage (Gado et al, 2014;Brand Bateman et al, 2020).…”