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

Abstract

Background: Understanding factors causing variation in family physicians/general practitioners (GPs) screening knowledge, understanding and support of organised population-based colorectal cancer (CRC) programs can direct interventions that maximise the influence of a CRC screening recommendation from a GP. This study aims to assess contextual factors that influence knowledge and quality improvement (QI) practice directed to CRC screening in Australian general practice. Methods: A convenience sample of anonymous general practice staff from all Australian states and territories completed a web-based survey. Multivariate analyses assessed the association between CRC screening knowledge and QI-CRC practice scores and patient, organisational and environmental-level contextual factors. Results: Of 1,013 survey starts, 918 respondents (90.6%) completed the survey. Respondents less likely to recommend FOBT screening had lower knowledge and QI practice scores directed to CRC screening. Controlling for individual and practice characteristics, respondents’ rating of the Australian National Bowel Cancer Screening Program (NBCSP) support for preventive care, attending external education, and sufficient practice resources to implement QI practice (generally) were the strongest factors associated with QI practice directed towards CRC screening. Knowledge scores were less amenable to the influence of contextual factors explored. Conclusion: More active engagement of family medicine/general practice to improve screening promotion could be achieved through better QI resourcing without changing the fundamental design of population-based CRC screening programs.

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

“…On a care team level, we found that outdated screening knowledge influenced PHCWs level of engagement in screening, with this finding also consistent with that of previous research 16,18 . Some PHCWs outlined that they were not adopting the new self‐collection cervical screening pathway due to their incorrect belief self‐collected swabs were not as accurate as clinician‐collected swabs.…”

“…29 On a care team level, we found that outdated screening knowledge influenced PHCWs level of engagement in screening, with this finding also consistent with that of previous research. 16,18 Some PHCWs outlined that they were not adopting the new selfcollection cervical screening pathway due to their incorrect belief self-collected swabs were not as accurate as clinician-collected swabs. Although there has previously been uncertainty around the sensitivity of a selfcollected swab, this has been addressed, with an updated meta-analysis demonstrating test performance for self-collected specimens to be equally sensitive to a clinician-collected specimen.…”

“…attitude towards cancer screening and knowledge of screening guidelines) to influence the engagement of PHCWs. [15][16][17][18] Further, evidence suggests that practice-targeted initiatives such as audit and feedback and office-system prompts within the context of wider organisational change, are an effective way to increase cancer screening participation rates. 15 An awareness of the factors that limit or promote engagement in cancer screening programs can aid PHCWs, as well as relevant program developers and policy makers, in addressing barriers and enhancing facilitators.…”

“…quality improvement activities and resources, a whole‐of‐practice approach, time and an identified practice champion to drive cancer screening initiatives) and care team level factors (e.g. attitude towards cancer screening and knowledge of screening guidelines) to influence the engagement of PHCWs 15-18 . Further, evidence suggests that practice‐targeted initiatives such as audit and feedback and office‐system prompts within the context of wider organisational change, are an effective way to increase cancer screening participation rates 15 .…”

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

“…40 It is notable that screening for bowel cancer has been recommended for people aged 45 years and above in the USA 41 and Australia. 42 In addition, it has been recently suggested in Australia that there may be opportunities to increase CRC screening participation rates by encouraging education for primary care physicians and support for quality improvement initiatives in primary care 43 ; such approaches should also consider the implications of the age-related patterns we have found.…”