General practitioner management related to skin cancer prevention and screening during standard medical encounters: a French cross-sectional study based on the International Classification of Primary Care

Abstract

ObjectiveThe aim of this study was to assess general practitioner (GP) management practices related to skin cancer prevention and screening during standard medical encounters.SettingData on medical encounters addressing skin cancer issues were obtained from a French database containing information from 17 019 standard primary care consultations.ParticipantsData were collected between December 2011 and April 2012 by 54 trainees who reported the regular practice of 128 GPs using the International Classification of Primary Care.Outcome measuresReasons for encounters and the following care processes were recorded: counselling, clinical examinations and referral to a specialist. Medical encounters addressing skin cancer issues were compared with medical encounters that addressed other health problems using a multivariate analysis.ResultsOnly 0.7% of medical encounters addressed skin cancer issues. When patients did require management of a skin cancer-related issue, this was more likely initiated by the doctor than the patient (70.7% vs 29.3%; p<0.001). Compared with medical encounters addressing other health problems, encounters that addressed skin cancer problems required more tasks (3.7 vs 2.5; p<0.001) and lasted 1 min and 20 s longer (p=0.003). GPs were less involved in clinical examinations (67.5% vs 97.1%; p<0.001), both complete (7.3% vs 22.3%, p<0.001) and partial examinations (60.2% vs 74.9%), and were less involved in counselling (5.7% vs 16.9%; p<0.001). Patients presenting skin cancer issues were referred to a specialist more often than patients consulting for other health problems (39.0% vs 12.1%; p<0.001). GPs performed a biopsy in 6.7% of all skin cancer-related encounters.ConclusionsThis study demonstrates discrepancies between the high prevalence of skin cancer and the low rate of medical encounters addressing these issues in general practice. Our findings should be followed by qualitative interviews to better understand the observed practices in this field.

Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists

“…In contrast, dermatologists reported at least pursuing proactive photodamage assessment in every patient, as they believed this is an important aspect of care. Related to this is the reported difference between GPs and dermatologists in consistently conducting FBSEs, which has also been found in a previous quantitative study …”

“…12 The perceived lack of knowledge and experience of AK among GPs is probably related to limited education on skin cancer management in GP training and may lead to a sense of feeling unqualified to perform skin cancer care. [23][24][25] Investing in improving GPs' knowledge of AK may increase GPs' confidence in performing AK and skin cancer care and subsequently lead to more standardized and uniform AK management in primary care. Additional training and promoting awareness among GPs were previously shown to result in GPs having a larger role in the treatment of AK and fewer referrals to secondary care.…”

“…Related to this is the reported difference between GPs and dermatologists in consistently conducting FBSEs, which has also been found in a previous quantitative study. 24 In the current setting, Dutch GPs primarily respond to the requests of patients, which are mostly lesion directed and do not include active overall assessments of photodamage. Although the risk of skin cancer and the need for treatment are low for those with solitary AK, both increase with the extensiveness of AK.…”

Burden of skin cancer in Colombia

“…In countries with a lower incidence of skin cancer, such as Colombia, the knowledge of general practitioners and the general population could be lower than in high incidence countries, because of this lower burden of skin cancer disease. It seems useful to improve the knowledge and skills of family physicians and general practitioners in recognizing suspected skin cancer lesions and to improve early detection 44 …”

A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting

“…Unfortunately, the available research suggests that about one-third of farmers may need additional evaluation due to identification of a concerning lesion as a result of screening [47]. Since farmers' sun protection practices tend to be unsatisfactory [45,47,48], it seems legitimate to implement targeted educational interventions and screening programmes in this risk group [47,48], especially as skin cancer prevention and screening may be uncommon in GP practice [49].…”