Improving colorectal cancer screening in general practice from obstacles to brief intervention

Datum: 23 mei 2014

Locatie: University of Antwerp - Campus Drie Eiken - Building Q - Promotiezaal - Universiteitsplein 1 - 2610 Wilrijk

Tijdstip: 14.30 uur

Organisatie / co-organisatie: Faculty of Medicine and Health Sciences

Promovendus: Isabelle Aubin-Auger

Promotor: Prof P. Van Royen and Prof L. Peremans

Korte beschrijving: PhD defense Isabelle Aubin-Auger - Faculty of Medicine and Health Sciences

Abstract: Colorectal cancer (CRC) is very common in western countries. Better survival rates are reached if CRC is detected at early stages. The gaiac faecal occult blood test (gFOBT) has proven effectiveness for screening populations at average risk of colorectal cancer. CRC mortality rate decreases with 15 to18% among 50 to 74 years old adults, tested every 2 years. A participation rate of at least 45% is desirable. Since 2008, mass screening with a gFOBT has been organized in France. In most French regions, as well as in many other countries, the target rate has not yet been reached. This doctoral thesis aims to explore barriers and facilitators of mass screening, the way French general practitioners (GPs) deliver the test and finally to develop a brief intervention to improve the participation rate. The first qualitative study explored the obstacles to mass colorectal screening with 24 patients' interviews and 5 GPs' focus groups. Numerous obstacles, from both physicians' and patients' perspectives were found. In order to improve mass screening, it is necessary to increase awareness and understanding of both GPs and patients regarding this process. GPs' performance during consultations in which patients ask for a FOBT, was explored in the second study focusing on two different aspects: the core content of the consultation and the communication style used between GPs and patients. Nine GPs audiotaped specific parts of 35 different consultations, when they discussed and delivered the FOBT. The core content included primarily biomedical statements largely dedicated to technical aspects. The communication style was not patient-centered, with an overwhelming verbal dominance of the GPs. In order to improve their communication with patients on CRC screening, we developed educational material and a training program for GPs. The content was based on data from the two previous studies. The objective of the last study was to test the efficacy of that training course with a cluster randomized trial. There was a significant difference for the patient's participation rate per GP in the intervention group versus the control group (p=0.03) but not for the secondary outcomes.