Strategies to improve cancer screening in general practice: are guidelines the answer?

Young, Jane; Ward, Jeanette

doi:10.1093/fampra/16.1.66

Cited by 14 publications

(8 citation statements)

References 20 publications

(11 reference statements)

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“…In May 1999, 60 GPs who had participated in research about preventive care (Young 2000) completed a baseline self‐administered questionnaire about EBM. Questions adapted from existing quantitative instruments (McColl et al 1998; Young & Ward 1999a; Young & Ward 1999b) addressed views of EBM (using visual analogue scales), understanding of technical terms used in EBM, barriers to EBM in general practice, preferred strategies to support EBM, familiarity with the Cochrane Library and Internet and use of computers at work. Personal and professional details of participants also were ascertained.…”

Section: Methodsmentioning

confidence: 99%

Evidence‐based medicine in general practice: beliefs and barriers among Australian GPs

Young

Ward

2001

Evaluation Clinical Practice

144

143

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If implemented, evidence-based medicine (EBM) in general practice will improve health outcomes for patients. This paper examines the views of 60 Australian general practitioners about EBM. While 57% of respondents had a computer in their surgery, 15% had Internet access and only 3% had access to the Cochrane Library at work. The most commonly cited barrier to EBM was 'patient demand for treatment despite lack of evidence for effectiveness' (45%). The next three most highly rated barriers related to lack of time. For each of three tasks of EBM, namely searching for evidence, appraising evidence and discussing the implications of evidence with patients, lack of time was rated as a 'very important barrier' by significantly more participants than lack of skills (McNemar's tests: chi2(1) = 7.1, P = 0.008, chi2(1) = 14.0, P = 0.001 and chi2(1) = 9.0, P = 0.003, respectively). Preferred resources for EBM included clinical practice guidelines (rated as 'very useful' by 55%) and journals that summarize research evidence, for example Evidence-based Medicine (52%). Systematic reviews were considered 'very useful' by only 15% of respondents, consistent with our finding that 30% did not understand the term 'systematic review'. Furthermore, 43% did not understand 'meta-analysis'. A minority indicated they understood the terms 'relative risk' (23%), 'absolute risk' (28%) and 'number needed to treat' (15%) sufficiently to explain to others. Skills development is crucial to achieve EBM in general practice.

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Section: Methodsmentioning

confidence: 99%

Evidence‐based medicine in general practice: beliefs and barriers among Australian GPs

Young

Ward

2001

Evaluation Clinical Practice

144

143

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“…Young et al showed that more than 40% of general practitioners reported that they were not aware of skin cancer screening guide-lines (40). Consequently, the establishment of national guide-lines might not be enough to improve cancer screening participation.…”

Section: Discussionmentioning

confidence: 99%

Time-trend of melanoma screening practice by primary care physicians: A meta-regression analysis

Valachis¹,

Mauri²,

Karampoiki³

et al. 2009

Upsala Journal of Medical Sciences

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ObjectiveTo assess whether the proportion of primary care physicians implementing full body skin examination (FBSE) to screen for melanoma changed over time.MethodsMeta-regression analyses of available data. Data Sources: MEDLINE, ISI, Cochrane Central Register of Controlled Trials.ResultsFifteen studies surveying 10,336 physicians were included in the analyses. Overall, 15%–82% of them reported to perform FBSE to screen for melanoma. The proportion of physicians using FBSE screening tended to decrease by 1.72% per year (P =0.086). Corresponding annual changes in European, North American, and Australian settings were −0.68% (P =0.494), −2.02% (P =0.044), and +2.59% (P =0.010), respectively. Changes were not influenced by national guide-lines.ConclusionsConsidering the increasing incidence of melanoma and other skin malignancies, as well as their relative potential consequences, the FBSE implementation time-trend we retrieved should be considered a worrisome phenomenon.

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“…(19,20,34) Several studies have reported that clinical practice guidelines are difficult and inconvenient to use. (15,34,35) Thus, to promote an appropriate understanding of cancer screening guidelines, they should be presented in a format that is easy for health professionals to understand and use.…”

Section: Discussionmentioning

confidence: 99%

“…(7)(8)(9)(10) Several studies have reported that various health professionals have different levels of knowledge about cancer screening. (11)(12)(13)(14)(15)(16)(17) It is important that health professionals have the correct information to encourage individuals to participate in cancer screening programs.…”

mentioning

confidence: 99%

Awareness of and adherence to cancer screening guidelines among health professionals in Japan

Hamashima¹,

Saitō²,

Sobue

2007

Cancer Science

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Since 1998 in Japan, guidelines for cancer screening programs have been developed and revised by a research group funded by the Ministry of Health, Labour and Welfare. However, little is known about health professionals' awareness of and adherence to the cancer screening guidelines. Surveys were conducted by mailing questionnaires to two target groups of health professionals: local government officers of municipal cancer screening programs of 3327 municipalities in 47 prefectures (local government officers group; n = 3327) and councilors of an academic society dealing with a mass survey of gastroenterological cancer (expert group; n = 195). The questionnaire contained questions dealing with: (1) awareness of and adherence to the cancer screening guidelines published in 2001, and (2) basic knowledge of and attitude towards cancer screening. We compared the responses of the two groups. The response rate in both groups was approximately 65%. Over 70% of the respondents were aware of the cancer screening guidelines. However, 20% of the local government officers and 35% of the experts thought that non-recommended methods could be used for population-based screening. Fifty-six percent of the local government officers and 76% of the experts responded that there was no problem with using non-recommended methods for opportunistic screening. Almost all health professionals believed that screening was 'almost always a good idea'. Although the two groups' backgrounds differed, both did not sufficiently understand the evidence-based approach for cancer screening. To properly conduct evidence-based cancer screening, it is necessary that health professionals have an appropriate understanding of the guidelines. There are two types of cancer screening: population-based screening and opportunistic screening. Although the aim of both screening programs is to reduce cancer mortality, their implementation differs.(2) In Japan, population-based screening programs are conducted in the following manner. The Health Service Law for the Aged introduced cancer screening programs in 1983. At present, five cancer screening programs (stomach, cervix, lung, breast and colon) are conducted nationwide, and over 25 million people are screened annually.(3) Before 1998, the national, prefectural and local (city, town and village) governments each paid one-third of the fees, and the local government had the primary responsibility of conducting the programs. In 1998, the national and prefectural governments stopped specific subsidies for cancer screening. Since that time, local governments have determined whether or not they conduct specific cancer screening programs; however, most of them continue to follow the official national government recommendations and offer five cancer screening programs. In addition, some offer new cancer screening modalities that are not supported by sufficient evidence of their reliability. For example, screening modalities using prostate-specific antigen (PSA) for prostate cancer and ultrasonography for breast cancer hav...

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Strategies to improve cancer screening in general practice: are guidelines the answer?

Cited by 14 publications

References 20 publications

Evidence‐based medicine in general practice: beliefs and barriers among Australian GPs

Evidence‐based medicine in general practice: beliefs and barriers among Australian GPs

Time-trend of melanoma screening practice by primary care physicians: A meta-regression analysis

Awareness of and adherence to cancer screening guidelines among health professionals in Japan

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