Endorsement by the Primary Care Practitioner Consistently Improves Participation in Screening for Colorectal Cancer: A Longitudinal Analysis

Abstract

Objectives To investigate the effect of general practice (GP) and general practitioner (GPR) endorsement for faecal occult blood test (FOBT)-based screening on maintenance of participation in screening over four successive screening rounds. Setting South Australian residents aged !50 years. Methods Random selection of four groups (n ¼ 600 per group): one from the Commonwealth electoral roll (ER) and three from the combined patient lists of two collaborating GPs (GP1, GP2, GP3). Subjects were mailed offers to screen using a faecal immunochemical test over four successive rounds, spaced approximately 18 months apart. The GP1 and ER groups were invited to screen without any endorsement from a GPR or medical practice; GP2 invitees received an invitation indicating support for screening from their medical practice; and GP3 invitations were printed on practice letterhead and were signed by a GPR. Results Multivariate analyses indicated that initial participation as well as re-participation over four successive rounds was significantly enhanced in the GP2 (39%, 42%, 45% and 44%) and GP3 groups (42%, 47%, 48% and 49%) relative to the ER group (33%, 37%, 40% and 36%). The analyses also indicated that 60 -69 year olds were most likely to participate in all rounds (relative risk [RR] 1.49, 1.39, 1.43 and 1.25), and men were generally less likely to participate than women in all screening rounds (RR 0.86, 0.84, 0.80 and 0.83). Conclusions Associating a GPR or medical practice of recent contact with an invitation to screen achieves better participation and re-participation than does an invitation from a centralized screening unit. Furthermore, enhanced participation can be achieved by practice endorsement alone without requiring actual GPR involvement.

Equity of colorectal cancer screening: which groups have inequitable participation and what can we do about it?

“…Consistent with other studies in Australia (Cole, Smith, Wilson, Turnbull, Esterman, & Young, 2007;Cole, Young, & Byrne, 2002;Zajac, Whibley, Cole, Byrne, Guy, Morcom et al, 2010) and internationally (Brouse et al, 2003;Damery, Clifford, & Wilson, 2010;Federici, Rossi, Bartolozzi, Farchi, Borgia, & Guastcchi, 2006;Ferreira, Dolan, Fitzgibbon, Davis, Gorby, Ladewski et al, 2005;Klabunde, Frame, Meadow, Jones, Nadel, & Vernon, 2003;Myers, Sifri, Hyslop, Rosenthal, Vernon, Cocroft et al, 2007;Rossi et al, 2005;Vernon, 1997), our study also revealed that doctor's recommendation and endorsement is one of the strongest predictors of CRC screening. Studies in the UK which use sigmoidoscopy as the method of CRC screening also highlight the importance of GP endorsement and recommendation (Brotherstone, Vance, Edwards, Miles, Robb, Evans et al, 2007;McCaffery, Borril, Williamson, Taylor, Sutton, Atkin et al, 2001;Power, Van Jaarsveld, McCaffery, Miles, Atkin, & Wardle, 2008;Robb, Power, Kralj-Hans, Edwards, Vance, Atkin et al, 2010;Sutton, Wardle, Taylor, McCaffery, Williamson, Edwards et al, 2000), although the relevance of these studies may be questioned due to the different type of CRC screening test used.…”

“…Studies in the UK which use sigmoidoscopy as the method of CRC screening also highlight the importance of GP endorsement and recommendation (Brotherstone, Vance, Edwards, Miles, Robb, Evans et al, 2007;McCaffery, Borril, Williamson, Taylor, Sutton, Atkin et al, 2001;Power, Van Jaarsveld, McCaffery, Miles, Atkin, & Wardle, 2008;Robb, Power, Kralj-Hans, Edwards, Vance, Atkin et al, 2010;Sutton, Wardle, Taylor, McCaffery, Williamson, Edwards et al, 2000), although the relevance of these studies may be questioned due to the different type of CRC screening test used. Nevertheless, If the potential benefits of bowel cancer screening are to be realised, GPs must be actively engaged (Damery et al, 2010;Klabunde, Lanier, Breslau, Zapka, Fletcher, Ransohoff et al, 2007;Zajac et al, 2010). Within our study, the engagement of and endorsement by GPs and nurse practitioners in the program and offering the screening test through them were highly recommended by the Anglo-Australian participants.…”

Ambivalence and Its Influence on Participation in Screening for Colorectal Cancer

“…This contrasts with previous research that has highlighted the importance of recommendations from health professions in the decision to screen for CRC (Costanza et al, 2005;Holt et al, 2009;Jones et al, 2010;Vedel et al, 2011;Zajac et al, 2010). However, the participants did identify indirect influences on their decision to screen, such as knowing others with CRC and media reports on the topic.…”

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

“…Our national trial of GPE significantly increased uptake overall. The effect size was smaller than in many previous studies, 36,196,216,217 but this was probably because most of those had used letters directly from the GP or had an individual GP's signature on the letter. In the NHS BCSP, all invitation letters come from the hubs; therefore, the only practical option was to include a banner noting that the individual's general practice supported the programme, but without individual GPs' names or signatures.…”