Identifier les facteurs d’adhésion des médecins généralistes au dépistage organisé du cancer colorectal – Enquête dans le Rhône

Abstract

BackgroundDuring the 2011–2012 colorectal cancer screening program organized in France, the rate of participation was 31.7 % nationally and only 28.5 % in one administrative district, Rhône. General practitioners (GPs) are key persons for convincing the population to do the Hemoccult II® test: 85 % of patients perform this test when the kit is delivered by their doctor. This work aims to identify determinants for the GP support and barriers for the test. MethodsThis was a declarative, prospective, observational study. Questionnaires were sent to 1386 GPs who had the material necessary for the organized screening program. The questionnaire focused on the GPs’ behavior concerning the colorectal cancer screening program, their patients’ feelings about the Hemoccult II® test, the GPs’ prevention attitude for colorectal cancer, and demographic and professional features. The GPs were divided into four quartiles according to the number of tests performed by their patients. This study was designed to identify factors favoring GP support for cancer colorectal screening. Items on the questionnaire were considered support determinant if the majority of the GPs expressed a favorable opinion, and otherwise were considered as a barrier. Univariate analysis detected variables exhibiting significant difference between quartiles. The two quartiles with the best support were compared with the two others using binary logistic regression. ResultsThe GPs’ participation rate in this study was 54.9 %. GP support was better for practitioners who were male (OR=1.6), practiced outside the city of Lyons (OR=3), and had more than 26 patients per day (OR=5). Other support determinants highlighted were: not actually thinking that “a patient expects the GP to introduce the discussion about colorectal cancer screening” (OR=2.3), and “introduce the discussion” (OR=1.8), “trusting in the biannual rhythm for screening” (OR=2.3), and “the Hemoccult II® test reliability” (OR=1.8). The bias usually inherent in declarative analysis was avoided here because this study linked GP responses with the number of tests carried out by their patients. ConclusionSatisfactory GP participation in this investigation enabled a better assessment of their support determinants and barriers regarding colorectal cancer screening program and target actions for the implementation of the future program with an immunological test.