Lucinda Bertels1, Sientje van der Heijden2, Maartje Hoogsteyns3, Evelien Dekker4, Kristel van Asselt5, Henk van Weert6, Bart Knottnerus5. 1. Medical Anthropologist and Sociologist, PhD candidate, Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 2. Final Year Medical Student, Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 3. Assistant Professor, Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 4. Professor, Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands. 5. Postdoctoral Researcher, Department of General Practice, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 6. Professor, Department of General Practice, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND: In the Dutch colorectal cancer (CRC) screening programme, individuals receive a faecal immunochemical test (FIT) to do at home. After a positive FIT result, a follow-up colonoscopy is recommended to identify CRC or advanced adenomas (AA). GPs may influence their patients' decisions on adherence to follow-up by colonoscopy. AIM: To explore GPs' perspectives on the CRC screening programme and their potential influence on FIT-positive patients to follow up with the recommended colonoscopy. DESIGN & SETTING: Semi-structured interviews among GPs in Amsterdam, the Netherlands. METHOD: GPs were approached using purposive sampling. Analysis was performed on 11 interviews using open coding and constant comparison. RESULTS: All interviewed GPs would recommend FIT-positive patients without obvious contraindications to adhere to a follow-up colonoscopy. If patients were likely to be distressed by a positive FIT result, most GPs described using reassurance strategies emphasising a low cancer probability. Most GPs stressed the probability of false-positive FIT results. Some described taking a positive screening result in CRC screening less seriously than one in breast cancer screening. Most GPs underestimated CRC and AA probabilities after a positive FIT result. When told the actual probabilities, some stated that this knowledge might change the way they would inform patients. CONCLUSION: These results imply that some of the interviewed GPs have too low a perception of the risk associated with a positive FIT result, which might influence their patients' decision-making. Simply informing GPs about the actual rates of CRC and AA found in the screening programme might improve this risk perception.
BACKGROUND: In the Dutch colorectal cancer (CRC) screening programme, individuals receive a faecal immunochemical test (FIT) to do at home. After a positive FIT result, a follow-up colonoscopy is recommended to identify CRC or advanced adenomas (AA). GPs may influence their patients' decisions on adherence to follow-up by colonoscopy. AIM: To explore GPs' perspectives on the CRC screening programme and their potential influence on FIT-positive patients to follow up with the recommended colonoscopy. DESIGN & SETTING: Semi-structured interviews among GPs in Amsterdam, the Netherlands. METHOD: GPs were approached using purposive sampling. Analysis was performed on 11 interviews using open coding and constant comparison. RESULTS: All interviewed GPs would recommend FIT-positive patients without obvious contraindications to adhere to a follow-up colonoscopy. If patients were likely to be distressed by a positive FIT result, most GPs described using reassurance strategies emphasising a low cancer probability. Most GPs stressed the probability of false-positive FIT results. Some described taking a positive screening result in CRC screening less seriously than one in breast cancer screening. Most GPs underestimated CRC and AA probabilities after a positive FIT result. When told the actual probabilities, some stated that this knowledge might change the way they would inform patients. CONCLUSION: These results imply that some of the interviewed GPs have too low a perception of the risk associated with a positive FIT result, which might influence their patients' decision-making. Simply informing GPs about the actual rates of CRC and AA found in the screening programme might improve this risk perception.
Entities:
Keywords:
Colorectal Cancer Screening; Colorectal Neoplasms; Early Detection of Cancer; Family Practice; Primary Health Care; Qualitative Research
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