Do you recommend cancer screening to your patients? A cross-sectional study of Norwegian doctors

Bringedal, Berit; Fretheim, Atle; Nilsen, Stein; Rø, Karin Isaksson

doi:10.1136/bmjopen-2019-029739

Cited by 5 publications

(8 citation statements)

References 18 publications

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“…The current study findings showed that more than three-fourths of the physicians referred a patient for cancer screening at some point in their clinical practice. Our findings regard cancer screening are higher for CRC in the Al-Qassim region of Saudi Arabia at 64.5% vs 42% in Norway; this might be due to the fact that the project for CRC screening has been initiated by the Ministry of Health recently, while in Norway, the program was not initiated at the time of the survey [ 4 ]. However, the figure is lower than CRC screening recommendation rates in Riyadh (92%) [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Survey items were based on a review of previous literature and were further validated by three consultants in preventive medicine and public health; they were tested through a pilot study among PHC physicians before the initiation of the study [ 4 , 21 - 23 ]. Reliability assessment for barriers for screening showed Cronbach's alpha to be 0.81 for system barriers, 0.72 for physicians' barriers, and 0.58 for patients' barriers; the overall Cronbach’s alpha was determined to be 0.838, which confirms that there is a high level of internal consistency and reliability for the questions used in eliciting participants’ responses on what they think to be the barriers to cancer screening recommendations.…”

Section: Methodsmentioning

confidence: 99%

“…Screening is the process of applying a test or examination for the early detection of the disease or a certain health event, thereby halting the disease progression and preventing complications [ 3 ]. Though screening as a principle provides hope, it remains debatable in terms of cost in comparison to the expected benefit and harms and whether other types of cancer of public health importance require more attention [ 4 ]. Different modalities are being used in cancer screening based on the type of cancer and the availability of that modality; one of the most common is mammography for breast cancer screening.…”

Section: Introductionmentioning

confidence: 99%

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Practices of Cancer Screening for Average-Risk Cancer Patients Among Primary Healthcare Center Physicians in Al-Qassim Region, Saudi Arabia

Aljohani¹,

Alsaykhan²,

Almutairi³

et al. 2023

Cureus

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Objective: Cancer screening programs exist in Saudi Arabia for some types of cancers. However, data on primary healthcare center (PHC) physicians' practices in referring patients for screening tests or procedures remain unclear.Methodology: A cross-sectional study was conducted with a self-reported survey that included 141 PHC physicians affiliated with the Ministry of Health in the Al-Qassim region of Saudi Arabia. The primary outcome was the practice of recommending to average-risk patients screening tests for different types of cancers including breast, colorectal, cervical, prostate, and lung, and testing if sociodemographic, specialty, job level, years of experience, a family history of cancer, and patients encountered per day affect their decisions. Secondary outcomes were the barriers perceived by physicians to recommending a screening test. p-value <0.05 was considered significant.Results: The study included 141 respondents, of which 60.3% were males, and the mean age of the entire population was 35.7 ± 8.3 years. The rate of recommending cancer screening varied by the type of cancer, with screening for colorectal cancer being the most prominent (64.5%), followed by breast cancer (51.8%). Fear of finding cancer, poor patient compliance, and difficulty in scheduling the test were the most common patient, physician, and system-related barriers as perceived by PHC physicians. Male physicians were less likely to recommend patients for breast (0.10, 95%CI 0.04-0.23, p < 0.001) and cervical (0.26, 95%CI 0.08-0.78, p = 0.017) cancer screening. However, they were 3.74 times more likely to recommend prostate cancer screening (95%CI 1.20-11.68, p = 0.023) and 5.79 times more likely to request lung cancer screening (95%CI 1.27-26.39, p = 0.023).Level of education, specialty, and being a senior physician were factors associated with cervical cancer screening. Physicians who work in non-general practice specialties were more likely to recommend cervical cancer screening than those who work in general practice (95%CI 0.04-0.48, p = 0.002). Senior physicians such as registrars/senior registrars and consultants were more likely to request or recommend a patient for breast cancer screening (2.85,) and cervical cancer screening (6.35,).Conclusion: Screenings for colorectal and breast cancer were the commonly recommended screening tests. Patients' fear of finding cancer, poor patient compliance, and delays or difficulty in scheduling the procedures were the commonly identified barriers as perceived by physicians that influenced physician decisions in referring patients for cancer screening. Our findings suggest that cancer screening rates may be improved by educating individuals on the benefit of early detection of cancers and providing assurance for them with regard to the availability of effective treatments. More research is needed on ways to overcome the obstacles physicians encounter and the outcomes of these measures with regard to improved screening practices.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Practices of Cancer Screening for Average-Risk Cancer Patients Among Primary Healthcare Center Physicians in Al-Qassim Region, Saudi Arabia

Aljohani¹,

Alsaykhan²,

Almutairi³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…2 The ambiguity about whether clinicians introduce discussion could lead to subjective screening decisions and impact the number of individuals counselled. 7 If the man is responsible, influences of their education level and health literacy may lead to health inequities. 8 Certain factors, such as African descent and family history, increase an individual's PCa risk.…”

Section: Discussionmentioning

confidence: 99%

Screening asymptomatic men for prostate cancer: A comparison of international guidelines on prostate-specific antigen testing

et al. 2022

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Objective To summarise and compare the key recommendations on prostate-specific antigen (PSA)-based screening for prostate cancer, and so highlight where more evidence is required to facilitate consistent recommendations. Methods The Medline database and websites of 18 national screening organisations and professional associations were searched between January 2010 and November 2020 to identify screening guidelines published in English, considering recent clinical trials. Results Population-based PSA testing of asymptomatic men is not widely recommended. Guidelines emphasize shared patient-clinician decision making. For ‘average-risk’ men choosing to be screened, the recommended age varies from 50–55 to 70 years, alongside consideration of life expectancy (ranging from 7–15 years). Screening intervals, when specified, are biennial (most common), annual, or determined from baseline PSA. The earliest age for screening high-risk men (frequently defined as of African descent or with a family history of prostate cancer) is 40 years, but recommendations often defer to clinical judgement. Conclusions Population screening of asymptomatic men is not widely recommended. Instead, balancing the potential harms and benefits of PSA testing is endorsed. Variation between guidelines stems from differing interpretations of key trials and could lead to clinician-dependent screening views. The development of clinical decision aids and international consensus on guidelines may help reduce national and international variation on how men are counselled.

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“…In an interesting recent study from Norway, where Pap smears are routinely carried out by PHC physicians, Bringedal et al examined doctors’ characteristics to determine whether and why doctors recommended disease-specific cancer screening to their patients [ 22 ]. The study revealed that PHC physicians adhered to cancer screening guidelines more in general and that they recommended cervical cancer screening at a significantly higher rate in comparison to other specialists.…”

Section: Discussionmentioning

confidence: 99%

Barriers and attitudes towards cervical cancer screening in primary healthcare in Poland - doctors’ perspective

et al. 2021

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Background Healthcare systems have adopted different strategies to reduce the burden of cervical cancer. In Poland, a population-based screening program was implemented in 2006, leading to a downward trend in cervical cancer burden. However, screening rates are still low in relation to other EU member states. In Poland, Pap smears are mainly performed by gynecologists rather than Primary Health Care (PHC) physicians. Little is known about the experiences and attitudes of the latter regarding cervical cancer screening in a PHC setting. Methods A cross-sectional questionnaire-based survey was carried out among 43 PHC physicians from the Malopolska region in Poland. Barriers and attitudes towards cytology in a PHC setting were evaluated. Results Approximately 35% of surveyed physicians reported having experience in performing cytology. Almost 75% of PHC physicians lacked the necessary equipment in their office to perform the screening. None of the studied physicians performed Pap smears in their office at the time. The reasons included: shortage of competence (78.57%) and time (69.05%), the perception of Pap smears as a task for gynecologists (69.05%), the lack of financial incentives (61.90%), and the belief that their patients would be unwilling to undergo the test in their PHC physician’s office (33.33%). More than three quarters (76.74%) declared they would be ready to perform Pap smears if the tests were additionally paid. No significant associations between PHC physicians’ characteristics and their willingness to perform cytology screening were found. Conclusion The primary barrier to perform Pap smears by PHC physicians does not lie in their personal reluctance but in the organization of the healthcare system. Provision of required training and proper funding allocation can likely improve the screening rate of cervical cancer in Poland.

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Do you recommend cancer screening to your patients? A cross-sectional study of Norwegian doctors

Cited by 5 publications

References 18 publications

Practices of Cancer Screening for Average-Risk Cancer Patients Among Primary Healthcare Center Physicians in Al-Qassim Region, Saudi Arabia

Practices of Cancer Screening for Average-Risk Cancer Patients Among Primary Healthcare Center Physicians in Al-Qassim Region, Saudi Arabia

Screening asymptomatic men for prostate cancer: A comparison of international guidelines on prostate-specific antigen testing

Barriers and attitudes towards cervical cancer screening in primary healthcare in Poland - doctors’ perspective

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