[Identifying barriers to screening for abdominal aortic aneurysm in general practice: Qualitative study of 14 general practitioners in Paris]

Abstract

Introduction: Abdominal aortic aneurysm (AAA) is a silent pathology with often fatal consequences in case of rupture. AAA screening, recommended in France and many other countries, has shown its effectiveness in reducing specific mortality. However, AAA screening rate remains insufficient.

Objective: To identify barriers to AAA screening in general practice.

Material and method: Qualitative study carried out during 2016 among general practitioners based in Paris.

Results: Fourteen physicians were included. Most of the barriers were related to the physician: unawareness about AAA and screening recommendations, considering AAA as a secondary question not discussed with the patient, abdominal aorta not included in cardiovascular assessment, no search for a familial history of AAA, AAA considered a question for the specialist, lack of time, lack of training, numerous screenings to propose, oversight. Some barriers are related to the patient: unawareness of the pathology and family history of AAA, refusal, questioning the pertinence of the doctor's comments, failure to respect the care pathway. Others are related to AAA: source of anxiety, low prevalence, rarity of complications. The remaining barriers are related to screening: cost-benefit and risk-benefit ratios, sonographer unavailability, constraint for the patient, overmedicalization.

Conclusion: Information and training of general practitioners about AAA must be strengthened in order to optimize AAA screening and reduce specific mortality.

Keywords: Abdominal aortic aneurysm; Anévrisme aorte abdominale; Barriers; Dépistage; Freins; General practice; Médecine générale; Screening.