Have we increased our efforts to identify strategies which encourage colorectal cancer screening in primary care patients? A review of research outputs over time.

Elise Mansfield,Rob Sanson-Fisher,Christopher Oldmeadow,Natalie Dodd,Mariko Carey

doi:10.1016/j.pmedr.2018.05.015

Abstract

Globally, colorectal cancer (CRC) screening rates remain suboptimal. Primary care practitioners are supported by clinical practice guidelines which recommend they provide routine CRC screening advice. Published research can provide evidence to improve CRC screening in primary care, however this is dependent on the type and quality of evidence being produced. This review aimed to provide a snapshot of trends in the type and design quality of research reporting CRC screening among primary care patients across three time points: 1993–1995, 2003–2005 and 2013–2015.Four databases were searched using MeSH headings and keywords. Publications in peer-reviewed journals which reported primary data on CRC screening uptake among primary care patients were eligible for inclusion. Studies meeting eligibility criteria were coded as observational or intervention. Intervention studies were further coded to indicate whether or not they met Effective Practice and Organisation of Care (EPOC) study design criteria.A total of 102 publications were included. Of these, 65 reported intervention studies and 37 reported observational studies. The proportion of each study type did not change significantly over time. The majority of intervention studies met EPOC design criteria at each time point.The majority of research in this field has focused on testing strategies to increase CRC screening in primary care patients, as compared to research describing rates of CRC screening in this population. Further research is needed to determine which effective interventions are most likely to be adopted into primary care.

Highlights

Colorectal cancer (CRC) is the third most diagnosed cancer and the fourth most common cause of cancer death (Ferlay et al, 2013)
colorectal cancer (CRC) screening recommendations are reported in clinical practice guidelines in the developed world and include FOBT, sigmoidoscopy and colonoscopy (Australian Cancer Network Colorectal Cancer Guidelines Committee, 2005; European Commission, 2010; U.S Preventive Services Task Force, 2008)
Clinical practice guidelines suggest that primary care providers (PCPs) provide risk-appropriate CRC screening advice (Australian Cancer Network Colorectal Cancer Guidelines Committee, 2005; European Commission, 2010; Sarfaty, 2008) and PCPs have a high-level of contact with those in the target age range for CRC screening (Britt et al, 2015)

Summary

Introduction

Colorectal cancer (CRC) is the third most diagnosed cancer and the fourth most common cause of cancer death (Ferlay et al, 2013). CRC screening recommendations are reported in clinical practice guidelines in the developed world and include FOBT, sigmoidoscopy and colonoscopy (Australian Cancer Network Colorectal Cancer Guidelines Committee, 2005; European Commission, 2010; U.S Preventive Services Task Force, 2008). Reported CRC screening rates within these programs are suboptimal, ranging from 7% to 68% (Klabunde et al, 2015) This highlights the urgent need to find effective strategies to increase participation in CRC screening. Clinical practice guidelines suggest that PCPs provide risk-appropriate CRC screening advice (Australian Cancer Network Colorectal Cancer Guidelines Committee, 2005; European Commission, 2010; Sarfaty, 2008) and PCPs have a high-level of contact with those in the target age range for CRC screening (Britt et al, 2015)

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