Introduction Ghana has seen a rise in the incidence of colorectal cancer (CRC) over the past decade. In 2011, the Ghana National Cancer Steering Committee created a guideline recommending fecal occult blood testing (FOBT) for CRC screening in individuals over the age of 50. There is limited data available on current Ghanaian CRC screening trends and adherence to the established guidelines. Methods We conducted a survey of 39 physicians working at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. The survey evaluates physician knowledge, practice patterns, and perceived personal-, patient- and system-level barriers pertaining to CRC screening. Results Almost 10% of physicians would not recommend colorectal cancer screening for asymptomatic, average risk patients who met the age inclusion criteria set forth in the national guidelines. Only 1 physician would recommend FOBT as an initial screening test for CRC. The top reasons for not recommending CRC screening with FOBT were the lack of equipment/facilities for the test (28.1%) and lack of training (18.8%). The two most commonly identified barriers to screening identified by >85% of physicians, were lack of awareness of screening/not perceiving colorectal cancer as a serious health threat (patient-level) and high screening costs/lack of insurance coverage (system-level). Conclusion Despite creation of national guidelines for CRC screening, there has been low uptake and implementation. This is due to several barriers at the physician-, patient- and system-levels including lack of resources and physician training to follow-up on positive screening results, limited monetary support and substantial gaps in knowledge at the patient level.

Pre-existing opioid use is common in kidney transplant patients with a significant amount continuing to use opioids post-transplant. 1 For kidney transplant patients, pre-transplant opioid use is more likely due to multiple sources of acute and chronic pain related to endstage renal disease (ESRD). 1 Pain in this population is typically managed with both non-opioid and opioid analgesics. 2 Surgical patients with pre-operative opioid use have a higher rate of post-operative opioid use when compared to opioid-naïve patients, which places kidney transplant recipients in a vulnerable position. 3,4 Although overall incidence remains low, use of opioids after kidney transplant has been associated with twofold increased risk of death and 68% increased risk of all-cause graft failure during the one year posttransplant period when high level opioid users were compared to patients with no opioid use. 1

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