Cancer Screening In General Practice Research Articles

Smoking cessation strategy in the national cervical cancer screening program (SUCCESS): study protocol for a pragmatic cluster randomised trial and process evaluation in Dutch general practice

IntroductionCervical cancer screening in general practice could be a routine moment to provide female smokers with stop smoking advice and support. The aim of this study is to assess the...

Smoking cessation advice after cervical screening: a qualitative interview study of acceptability in Dutch primary care.

Cervical cancer screening in general practice could be a routine and opportune moment to advise females who smoke to stop smoking. The aims of this study were to investigate the attitudes of females who smoke to receiving advice about stopping smoking after cervical screening and to identify factors associated with the acceptability of this advice. This qualitative interview study was conducted with Dutch females who smoked, had undergone cervical screening, and were aged 30 to 60 years. Interviews were performed between December 2016 and September 2017. In this study 15 participants were interviewed and transcripts were analysed using thematic analysis. Females who smoke were ambivalent (positive or sceptical) about being advised to stop smoking after they had undergone cervical screening. An explanation of why smoking behaviour is addressed by the practice assistant performing the smear, and making females feel at ease during the smear test, were found to be factors that might influence acceptability of such advice. Although a personal and non-judgemental approach to discussing smoking was considered essential, participants expressed different preferences regarding the form and content of cessation support. This was reflected by the variations in knowledge about smoking cessation support, previous experiences of cessation attempts, and received cessation advice or support. Study participants had mixed opinions about being given advice about smoking cessation after their cervical smear test and differed in their preferences for the type of support for smoking cessation. An interactive approach might improve how well a smoking cessation intervention is received by females who smoke and cater to their individual needs and preferences.

The readiness of German GPs to recommend and conduct cancer screening is associated with patient–physician gender concordance. Results of a survey

Background: Cancer screening participation rates in Germany differ depending on patients’ gender. International studies have found that patient–physician gender concordance fosters recommendation and conducting of cancer screening, and especially cancer screening for women.Objectives: We aimed to ascertain whether gender concordance influences general practitioners' (GPs’) rating of the usefulness of cancer screening, as well as their recommendations and readiness to conduct cancer screening in general practice in Germany.Methods: For an exploratory cross-sectional survey, 500 randomly selected GPs from all over Germany were asked to fill in a questionnaire on cancer screening in general practice between March and June 2015. We asked them to rate the usefulness of each cancer screening examination, how frequently they recommended and conducted them and whether they viewed GPs or specialists as responsible for carrying them out. We used multiple logistic regression to analyse gender effect size by calculating odds ratios.Results: Our study sample consisted of 139 GPs of which 65% were male. Male and female GPs did not differ significantly in their rating of the general usefulness of any of the specified cancer screening examinations. Male GPs were 2.9 to 6.8 times as likely to consider GPs responsible for recommending and conducting PSA testing and digital rectal examinations and were 3.7 to 7.9 times as likely to recommend and conduct these examinations on a regular basis.Conclusion: Patient–physician gender concordance made it more likely that male-specific cancer screenings would be recommended and conducted, but not female-specific screenings.KEY MESSAGES Male GPs are more likely than female GPs to view GPs as responsible for recommending and conducting male-specific cancer screening.Men consult urologists less frequently than women consult gynaecologists, so male GPs seem to take on the role of ‘doctor for men’.

Screening for Lung Cancer: It Works, but Does ItReallyWork?

After the publication of the NLST (National Lung Screening Trial) results, physicians will be faced with whether to begin ordering low-dose computed tomography (LDCT) of the chest to screen for lung cancer in patients with a history of tobacco use. Despite the encouraging reduction in deaths observed by using LDCT in the NLST study population, recommending adoption of lung cancer screening in general practice is premature. Lessons learned from prostate and breast cancer screening should remind us that the reductions in deaths expected with screening are unfortunately not as readily achievable as initially believed. Furthermore, the potential harms of false-positive findings on chest computed tomography are very real. The morbidity and even mortality associated with invasive diagnostic testing and surgical resection due to false- and true-positive findings on computed tomography are likely to increase when the approach taken in the NLST is applied in non-specialty care settings and among the population at highest risk, namely, those with smoking-related comorbid conditions. Although the NLST results are perhaps encouraging, they do not tell us enough that we can be sure that patients who undergo LDCT in an attempt to find early-stage lung cancer will have more benefit than harm.

Conducting oral examinations for cancer in general practice: what are the barriers?

The incidence of oral (mouth) cancer in the UK is continuing to rise. Individuals who are at greatest risk rarely visit a dentist but do consult general medical practitioners (GMPs). Therefore, GMPs could have an important role in the early detection of oral cancer. Research has shown that GMPs do not opportunistically screen high-risk individuals; however, the barriers to screening are poorly understood. To understand the reasons why GMPs may not screen for oral cancer. A questionnaire was developed, using the Theory of Planned Behaviour (TPB), to measure GMPs attitudes to and screening for oral cancer. The questionnaire was designed using all the key theoretical constructs of the TPB and incorporating the themes identified in a qualitative elicitation study. The questionnaire was posted to 499 GPs in Surrey Primary Care trust. Two hundred and twenty-eight completed questionnaires were returned (46%). Two TPB constructs [subjective norm (e.g. peer pressure) and perceived external control factors (e.g. adequate equipment, time constraints)] were identified as significant predictors of 'intention' to perform oral screening. Intention and perceived internal control factors (e.g. self-efficacy) were predictive of actually performing oral screening with patients. The results of the study suggest that there is considerable potential for improving intention to perform oral cancer screening in general practice. Theory-based interventions could include further training to enhance confidence, expertise, knowledge and ease of examination, the provision of adequate equipment in the surgery and increasing the motivation to comply with significant others by introducing guidelines on opportunistic screening.

Improving population-based cervical cancer screening in general practice: effects of a national strategy.

To assess the effects of a Dutch national prevention programme, aimed at general practitioners (GPs), on the adherence to organizational guidelines for effective cervical cancer screening in general practice. To identify the characteristics of general practices determining success. A prospective questionnaire study with pre- and post-measurement (before and 15 months after the introduction of the national programme). A random sample of one-third of all 4758 Dutch general practices. One GP was asked to participate per practice. A national GP prevention programme to improve population-based prevention of cervical cancer combining various methods for quality improvement in general practice, performed on a national, district and practice level. Outreach visitors were a key strategy in bringing about behavioural changes. The proportion of practices adhering to 10 recommendations (in four guidelines) to organize effective cervical cancer screening. After 15 months, all Dutch practices showed significant improvement in adherence to nine out of 10 recommendations. Two recommendations, in particular 'identifying women who should be medically excluded from screening' and 'sending a reminder to non-compliers' showed the largest absolute increases of 26% and 33%, respectively. Besides more intensive support of outreach visitors, practice characteristics such as 'computerization' and 'delegation of many clinical tasks to the practice assistant' were important in improving the adherence to guidelines. The national programme, with a combination of various methods for quality improvement, appeared to be effective in improving the organization of cervical screening in general practice. Computerization and, to a lesser extent, delegation of many clinical tasks to the practice assistant and more intensive support to practices, positively influenced the effectiveness of the national programme.

Strategies to improve cancer screening in general practice: are guidelines the answer?

GPs are ideally placed to recommend appropriate cancer screening for their patients. However, opportunities to discuss screening are often missed and screening procedures are not always recommended in accordance with national policy. The development of clinical practice guidelines represents one strategy for improving cancer screening in general practice. We aimed to ascertain Australian GPs' ratings of current clinical practice guidelines and their views of the likely usefulness of 18 strategies to improve cancer screening in general practice. A self-administered questionnaire was mailed to a national random sample of 1271 GPs in May 1996. Responders rated the usefulness of each of eight clinical practice guidelines current at the time of the survey. They then rated the usefulness of each of 18 strategies for support of cancer screening. We received 855 completed questionnaires (a 67% response rate). There was greatest support for guidelines already available on breast and cervical cancer. The most popular strategy to improve cancer screening was seminars with experts in preventive care, rated as 'very useful' by 658 (77%), followed by NHMRC guidelines (597, 70%) and pamphlets for patients (587, 69%). There was less support for more innovative strategies including assessment and feedback (35%), case finding by nurse practitioners (11%) and academic detailing (10%). Responders indicated that strategies involving passive dissemination of information would be most useful for improving cancer screening in general practice. Identification of an effective combination of acceptable initiatives is needed.

Accuracy of women's recall of opportunistic recruitment for cervical cancer screening in general practice.

Evaluation of strategies to improve opportunistic recruitment via general practice of women overdue for a cervical smear requires an accurate behavioural measure. As part of an experimental trial to evaluate the effect of a postgraduate workshop on preventive care, we conducted this methodological study to determine the accuracy of women's recall of an opportunistic discussion about cervical screening, by comparing it against audiotapes (n = 524). Taking the taped evidence of the trainee's verbal behaviour as the gold standard, sensitivity was 85 per cent (95 per cent confidence interval (CI) 73.1 to 92.0 per cent) and specificity was 78 per cent (CI 73.9 to 81.6 per cent). Given the low rate of opportunistic recruitment by trainees in the main study, only one-third of positive recollections by women of an opportunistic discussion about cervical screening were correct. Until other measures have been validated, women's recall may continue to be used to measure general practitioners' behaviour, but an appreciation of likely bias is recommended.

The effect on compliance of a health education leaflet in colorectal cancer screening in general practice in central England.

OBJECTIVE: To raise compliance in a general practice based colorectal cancer screening programme by the use of a simple health educational leaflet. DESIGN: A randomised controlled trial of the leaflet's...

Implementation of the national cervical cancer screening in general practice and feasibility of a general practice-based call system: the GP's opinion.

Thus far, the response to the nationwide screening programme for cervical cancer in The Netherlands, which was started in 1989, has been disappointing. One way to improve response is to involve general practitioners in the call system. A postal survey was conducted to review the implementation of the current screening programme in general practice and to examine the willingness of general practitioners to participate in a general practice-based call system. The response rate to the survey was 90%. The general practitioners were dissatisfied with follow-up, cost and time spent and compliance of women. Of all respondents 60% had already set up a call system within the practice or were willing to do so; another 31% were willing to participate in a regionally organized practice-based call system. On the basis of the results of this study a centralized general practice-based call system is recommended. The next step is to study the applicability of this system in a pilot programme.

Accuracy of women's recall of opportunistic recruitment for cervical cancer screening in general practice

Accuracy of women's recall of opportunistic recruitment for cervical cancer screening in general practice