Abstract
BackgroundColorectal cancer (CRC) is the second most frequent cause of cancer death in Australia. Early detection can reduce incidence and mortality. General practice-based initiatives have been proposed to improve CRC screening rates but to date have had modest impact. As there is limited research into the patient experience of CRC screening decision making, this study explored patient perspectives on CRC screening and the potential role for general practice.MethodsTen participants, aged between 50 and 74, from a general practice in South Australia were recruited by practice staff. Semi-structured interviews were conducted. Concurrent data collection and analysis were performed, guided by interpretative phenomenological analysis.ResultsTwo key themes were evident: attitudes toward screening and potential roles for general practice. Participants structured the experience of screening in terms of being proactive, ambivalent or avoidant. Roles for general practice centred on tasks as educators, trusted advisors, monitors and screeners. Mixed views on whether general practice involvement was necessary prompted consideration of additional sources of health information and motivation around screening.ConclusionsExploration of the patient experience provides insight into how participants make sense of screening and perceived roles for general practice (or other agents) in screening. There is satisfaction with current Government-driven processes but perceived value in general practice playing a complementary part in increasing screening rates. A multifaceted strategy, accounting for attitudes, is required to improve screening and population health outcomes.
Highlights
Colorectal cancer (CRC) is the second most frequent cause of cancer death in Australia
CRC can be detected before symptom development national guidelines recommend biennial screening using non-invasive Faecal Occult Blood Tests (FOBT) from the ages of 50–74 years [2]
Positive attitudes and prior screening experience have consistently emerged as enabling factors. The latter may refer to FOBT experience, with Australian re-participation rates over 70% [3], with higher re-participation rates believed to be due to familiarity with screening culture and regularly participating in breast/cervical screening [9]
Summary
Colorectal cancer (CRC) is the second most frequent cause of cancer death in Australia. Based on evidence that FOBT screening can reduce CRC mortality, in 2006 the Australian Government introduced the National Bowel Cancer Screening Program (NBCSP) [1]. Barriers and enablers to CRC screening For individuals, consistently identified barriers to CRC screening relate to: lack of time, procrastination, forgetfulness, other priorities, ambivalence, disvalue of testing, low perception of risk, lack of understanding, fear of results, language difficulties, low socioeconomic status, living in rural locations, age (below 60, over 75), male. Positive attitudes and prior screening experience have consistently emerged as enabling factors. The latter may refer to FOBT experience, with Australian re-participation rates over 70% [3], with higher re-participation rates believed to be due to familiarity with screening culture and regularly participating in breast/cervical screening [9]. The most frequently described enabler has been encouragement from others, health professionals [7, 13]
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