Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before-after and parallel group surveys

Kevin Selby; Jacques Cornuz; David Gachoud; Jean-Luc Bulliard; Cristina Nichita; Gian Dorta; Cyril Ducros; Reto Auer

doi:10.1136/bmjopen-2016-011086

Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before-after and parallel group surveys

BMJ Open. 2016 May 13;6(5):e011086. doi: 10.1136/bmjopen-2016-011086.

Authors

Kevin Selby¹, Jacques Cornuz¹, David Gachoud², Jean-Luc Bulliard³, Cristina Nichita⁴, Gian Dorta⁴, Cyril Ducros⁵, Reto Auer⁶

Affiliations

¹ Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
² Department of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland Education Unit, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
³ Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
⁴ Department of Gastroenterology and Hepatology, University Hospital of Lausanne, Lausanne, Switzerland.
⁵ Canton of Vaud Foundation for Cancer Screening, Lausanne, Switzerland.
⁶ Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.

Abstract

Objectives: Primary care physicians (PCPs) should prescribe faecal immunochemical testing (FIT) or colonoscopy for colorectal cancer screening based on their patient's values and preferences. However, there are wide variations between PCPs in the screening method prescribed. The objective was to assess the impact of an educational intervention on PCPs' intent to offer FIT or colonoscopy on an equal basis.

Design: Survey before and after training seminars, with a parallel comparison through a mailed survey to PCPs not attending the training seminars.

Setting: All PCPs in the canton of Vaud, Switzerland.

Participants: Of 592 eligible PCPs, 133 (22%) attended a seminar and 106 (80%) filled both surveys. 109 (24%) PCPs who did not attend the seminars returned the mailed survey.

Intervention: A 2 h-long interactive seminar targeting PCP knowledge, skills and attitudes regarding offering a choice of colorectal cancer (CRC) screening options.

Outcome measures: The primary outcome was PCP intention of having their patients screened with FIT and colonoscopy in equal proportions (between 40% and 60% each). Secondary outcomes were the perceived role of PCPs in screening decisions (from paternalistic to informed decision-making) and correct answer to a clinical vignette.

Results: Before the seminars, 8% of PCPs reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 33% foresaw having their patients screened in equal proportions (p<0.001). Among those not attending, there was no change (13% vs 14%, p=0.8). Of those attending, there was no change in their perceived role in screening decisions, while the proportion responding correctly to a clinical vignette increased (88-99%, p<0.001).

Conclusions: An interactive training seminar increased the proportion of physicians with the intention to prescribe FIT and colonoscopy in equal proportions.

Keywords: MEDICAL EDUCATION & TRAINING; PRIMARY CARE.

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MeSH terms

Adult
Attitude of Health Personnel
Colonoscopy*
Colorectal Neoplasms / diagnosis*
Early Detection of Cancer / methods
Female
Health Knowledge, Attitudes, Practice
Humans
Inservice Training / methods*
Male
Mass Screening / methods
Middle Aged
Occult Blood*
Physician's Role
Physicians, Primary Care / education*
Pilot Projects
Practice Patterns, Physicians' / statistics & numerical data*