From participation to diagnostic assessment: a systematic scoping review of the role of the primary healthcare sector in the National Bowel Cancer Screening Program

Abstract

Primary health care (PHC) plays a vital support role in organised colorectal cancer (CRC) screening programs by encouraging patient participation and ensuring timely referral for diagnostic assessment follow up. A systematic scoping review of the current evidence was conducted to inform strategies that better engage the PHC sector in organised CRC screening programs. Articles published from 2005 to November 2019 were searched across five databases. Evidence was synthesised and interventions that specifically require PHC involvement were mapped to stages of the CRC screening pathway. Fifty-seven unique studies were identified in which patient, provider and system-level interventions align with defined stages of the CRC screening pathway: namely, identifying/reminding patients who have not responded to CRC screening (non-adherence) (n=46) and follow up of a positive screen referral (n=11). Self-management support initiatives (patient level) and improvement initiatives (system level) demonstrate consistent benefits along the CRC screening pathway. Interventions evaluated as part of a quality-improvement process tended to report effectiveness; however, the variation in reporting makes it difficult to determine which elements contributed to the overall study outcomes. To maximise the benefits of population-based screening programs, better integration into existing primary care services can be achieved through targeting preventive and quality care interventions along the entire screening pathway.

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

“…We undertook a cross-sectional web-based survey, informed by a recent systematic scoping review (Holden et al, 2020), to explore individual, practice and contextual factors that might influence screening recommendations in Australian general practice.…”

“…A three-level (patient, organisation and environmental) complexity framework of contextual factors, modified from Lau et al (Lau et al, 2016), was applied with selected factors identified from the literature (Holden et al, 2020):…”

General practice perspectives on a bowel cancer screening quality improvement intervention using the Consolidated Framework for Implementation Research

“…Our recent systematic review found that interventions that were part of a quality improvement (QI) process maximised use of GPs' influence in recommending CRC screening participation, particularly for underscreened or never-screened patients. 6 However, the variation in reporting means that it is unclear which QI elements contribute to the overall study outcomes. 6 Based on our review and a general practice survey 10 , we developed a multicomponent CRC-QI intervention comprising eight elements to support delivery of the NBCSP in general practice ( Table 1).…”

“…6 However, the variation in reporting means that it is unclear which QI elements contribute to the overall study outcomes. 6 Based on our review and a general practice survey 10 , we developed a multicomponent CRC-QI intervention comprising eight elements to support delivery of the NBCSP in general practice ( Table 1).…”

“…4 Little is known about contextual factors that influence whether GPs advise their eligible patients to be screened. 5 Indeed, in Australia, there has been little empirical research exploring primary care facilitators of, and barriers to, screening since the NBCSP was introduced in 2006 6 , reflecting the limited role of primary care in the original program design. 3 The NBCSP is well established in delivering CRC screening kits (faecal occult blood tests [FOBTs]) to the households of eligible patients (aged 50-74 years) and contributes to reducing CRC morbidity and mortality.…”