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BackgroundAlthough largely preventable, Australia has one of the highest rates of bowel cancer in the world. General Practitioners (GPs) have an important role to play in prevention and early detection of bowel cancer, however in Australia this is yet to be optimised and participation remains low. This study sought to understand how GPs’ perceptions of bowel screening influence their attitudes to, and promotion of the faecal occult blood test (FOBT), to identify opportunities to enhance their role.MethodsInterviews were conducted with 31 GPs from metropolitan and regional New South Wales (NSW), Australia. Discussions canvassed GPs’ perceptions of their role in bowel screening and the national screening program; perceptions of screening tests; practices regarding discussing screening with patients; and views on opportunities to enhance their role. Transcripts were coded using Nvivo and thematically analysed.ResultsThe study revealed GPs’ perceptions of screening did not always align with broader public health definitions of ‘population screening’. While many GPs reportedly understood the purpose of population screening, notions of the role of asymptomatic screening for bowel cancer prevention were more limited. Descriptions of screening centred on two major uses: the use of a screening ‘process’ to identify individual patients at higher risk; and the use of screening ‘tools’, including the FOBT, to aid diagnosis. While the FOBT was perceived as useful for identifying patients requiring follow up, GPs expressed concerns about its reliability. Colonoscopy by comparison, was considered by many as the gold standard for both screening and diagnosis. This perception reflects a conceptualisation of the screening process and associated tools as an individualised method for risk assessment and diagnosis, rather than a public health strategy for prevention of bowel cancer.ConclusionThe results show that GPs’ perceptions of screening do not always align with broader public health definitions of ‘population screening’. Furthermore, the way GPs understood screening was shown to impact their clinical practice, influencing their preferences for, and use of ‘screening’ tools such as FOBT. The findings suggest emphasising the preventative opportunity of FOBT screening would be beneficial, as would formally engaging GPs in the promotion of bowel screening.

Issue addressed Bowel cancer is Australia's second biggest cancer killer. Yet, despite the existence of a free national bowel-screening program, participation in this program remains low. The aim of the present study was to understand the current factors contributing to this trend to help inform future strategies to increase participation. Methods Eight focus groups (n=61 in total) were conducted with participants aged 45 years and over from metropolitan and regional New South Wales (NSW). Discussions canvassed awareness, knowledge, attitudes and beliefs regarding bowel cancer and screening, and explored how these factors influenced decisions to screen. Results The low public profile of bowel cancer compared with other cancers, together with poor knowledge of its prevalence and treatability, has contributed to a low perception of risk in the community. Minimal understanding of the often-asymptomatic presentation of bowel cancer and the role of screening in prevention has appeared to compromise the perceived value of screening. In addition, confusion regarding when, and how often, individuals should screen was apparent. Knowledge of bowel cancer and screening, and its role in motivating intention to screen, emerged as a dominant theme in the data. Conclusions The present study highlights specific knowledge gaps and confusion with regard to bowel cancer and screening. Addressing these gaps through the provision of clear, coordinated information may shift attitudes to screening and increase participation. So what? Given the Australian Government's recent commitment to expand the National Bowel Cancer Screening Program, insight into what is driving current perceptions, attitudes and subsequent participation in bowel cancer screening is crucial to the development and targeting of new approaches and initiatives.

The links between tobacco smoking, and periodontal disease and oral cancer make the inclusion of smoking cessation interventions at dental visits an important prevention strategy in oral health services. The 5As (Ask, Advise, Assess, Assist, Arrange), which utilises a stages of change model, is the most commonly recognised framework for the provision of smoking cessation brief interventions and is advocated widely. While the popularity of the 5As continues, increasingly evidence suggests that staged-based interventions in smoking cessation may not be the best approach. Lack of time and expertise are also cited by health professionals as barriers to undertaking brief interventions and thus abbreviated forms of the 5As have been advocated. In 2009, NSW Health introduced a mandatory policy for public dental services in NSW to conduct smoking cessation brief interventions at the chairside based on a three-step approach, which is currently being evaluated. Given the debate and the pending evaluation results, this paper reviews models of smoking cessation brief interventions, to contribute to achieving a best practice model for public oral health in NSW.