Abstract
BackgroundPrimary health care (PHC) professionals play a key role in population screening of colorectal cancer. The purposes of the study are: to assess knowledge and attitudes among PHC professionals with regard to colorectal cancer screening, as well as the factors that determine their support for such screening.MethodsQuestionnaire-based survey of PHC physicians and nurses in the Balearic Islands and in a part of the metropolitan area of Barcelona.ResultsWe collected 1,219 questionnaires. About 84% of all professionals believe that screening for colorectal cancer by fecal occult blood test (FOBT) is effective. Around 68% would recommend to their clients a colorectal cancer screening program based on FOBT and colonoscopy. About 31% are reluctant or do not know. Professionals perceive the fear of undergoing a colonoscopy as the main obstacle in getting patients to participate, and the invasive nature of this test is the main reason behind their resistance to this program. The main barriers to support the screening program among PHC professionals are lack of knowledge (nurses) and lack of time (physicians). On multivariate analysis, the factors associated with reluctance to recommend colorectal cancer screening were: believing that FOBT has poor sensitivity and is complicated; that colonoscopy is an invasive procedure; that a lack of perceived benefit could discourage client participation; that only a minority of clients would participate; thinking that clients are fed up with screening tests and being unaware if they should be offered something to ensure their participation in the programme.ConclusionsTwo in every three PHC professionals would support a population screening program for colorectal cancer screening. Factors associated with reluctance to recommend it were related with screening tests characteristics as sensitivity and complexity of FOBT, and also invasive feature of colonoscopy. Other factors were related with patients' believes.
Highlights
Primary health care (PHC) professionals play a key role in population screening of colorectal cancer
Since the year 2000, a pilot program for population colorectal cancer screening based on fecal occult blood test (FOBT) and colonoscopy has been in place in the southern metropolitan area of Barcelona (115,867 inhabitants)
Variables We explored the following variables: socio-demographic; professional; knowledge about colorectal cancer; knowledge about cancer screening; the performance of FOBT; attitudes towards implementing a colorectal cancer screening program based on FOBT and colonoscopy for cases with positive stools; perceived obstacles to client participation; reasons, from a professional standpoint, for reluctance to encourage clients to participate; barriers against enlisting the collaboration of PHC professionals and, viewpoints on what to offer professionals to ensure their support to the program
Summary
Primary health care (PHC) professionals play a key role in population screening of colorectal cancer. Colorectal cancer is an important health problem in developed countries, both because of its high incidence and because it is accompanied by high mortality. There is hard evidence that colorectal cancer screening with fecal occult blood test (FOBT) and a colonoscopy on cases with positive FOBT, addressed to the population aged 50 to 74 years, effectively reduces colorectal cancer mortality and incidence [3], and clearly fulfills all the criteria of the World Health Organization for the development of a population screening program [4]. One crucial element for the success of populationbased screening programs is the participation of a large percentage of the population (more than 50%) [9]. It has been noted that individuals who refuse to participate are precisely those at highest risk of developing colorectal cancer [10]
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