General practitioner perspectives on barriers and enablers to bowel cancer screening in rural Tasmania: A thematic analysis of face-to-face interviews

Abstract Despite the health and economic benefits associated with mail-out colorectal cancer (CRC) screening, participation in programs across the world is suboptimal. A letter from the recipient’s general practitioner (GP) endorsing program participation has been shown to have a consistent, but modest, effect on screening uptake; however, the mechanisms by which GP endorsement is effective have not been investigated. The purpose of the present study was to evaluate the potential utility of GP endorsement letters or SMS in the context of facilitating bowel cancer screening in previous nonparticipants and to identify mechanisms underlying responses. A cross-section of nonparticipants in the Australian National Bowel Cancer Screening Program (N = 110) was randomly assigned to view a letter or SMS from a GP endorsing participation via an online survey. Ordinal responses reflecting effectiveness of, and influences on, GP endorsement were collected along with open questions regarding other potential endorsers. Percentages, means, and 95% confidence intervals were calculated and compared. Fifty-two percent of the sample agreed that GP endorsement would encourage their future participation. Responses did not differ between SMS and letter formats. Trust in the GP had significantly more influence on response to GP endorsement than the credibility or medical knowledge. Other health professionals and cancer survivors were commonly suggested as alternative sources of endorsement. Interventions to improve CRC screening participation could benefit from the routine implementation of GP endorsement from GPs, other trusted health professionals, or cancer survivors, particularly by encouraging people who forget or procrastinate over collecting a stool sample.

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Bowel Cancer Screening Participation in Rural Tasmania: A Comparative Case Study of Four Local Government Areas

Journal of Global Oncology ◽

10.1200/jgo.18.65200 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 14s-14s

Author(s):

A. Cooper ◽

S. Lee ◽

T. Barnett

Keyword(s):

Cancer Screening ◽

Local Government ◽

Thematic Analysis ◽

Screening Program ◽

Bowel Cancer ◽

Participation Rates ◽

Community Members ◽

Screening Participation ◽

Cancer Screening Program ◽

Bowel Cancer Screening

Background: Bowel cancer is a preventable condition, yet it is the second most common cancer after prostate cancer, with one in 12 Australians developing the disease by age 85. If detected early, the chances of survival are very high. One way to detect bowel cancer before it becomes a problem is through the use of a screening kit. The Australian government has distributed free kits to specific age groups since 2006, through their National Bowel Cancer Screening Program (NBCSP). Participation in the NBCSP is currently quite low (39% Australia-wide). In Tasmania, participation rates among local government areas (LGAs) range from 28% to 47%. These differences in participation are especially apparent in rural and remote areas and form the focus of this research. Aim: Our research aims to determine why there are marked differences in National Bowel Cancer Screening Program participation rates between rural LGAs in Tasmania. Secondary aims include developing future strategies for increased screening uptake in rural Tasmania. Method: A total of four LGAs, identified as having either high (n=2) or low (n=2) NBCSP participation rates, were included in the study. Face to face interviews with community members and stakeholders across the four LGAs were recorded and transcribed to obtain qualitative data. A total of 50 male and female community members aged 50-75 were recruited and interviewed regardless of whether they had used the NBCSP kit. A total of 28 health professionals including doctors, pharmacists, nurses and health promotion officers, working in each of the four LGAs were also interviewed. All interviews were recorded and transcribed. Thematic analysis was conducted to elucidate common barriers and enablers for screening, as well as suggestions for increasing NBCSP participation rates in Tasmania. Demographic data including age, gender, and educational attainment were collected from community members to further identify potential associations with screening participation. Results: All interviews have been successfully completed and transcribed, and thematic analysis has begun. Themes emerging from the data to date include the importance of community connectedness; the role of women in encouraging men to screen; health literacy; new/transient versus established/stable communities; and access to follow-up colonoscopies. Final results will be available shortly and presented in full. Conclusion: The findings from this study will highlight differences and reasons for screening participation in four rural Tasmanian LGAs. The results will have implications for the NBCSP in terms of recommendations for increasing participation in the program.

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Are there ethnic and religious variations in uptake of bowel cancer screening? A retrospective cohort study among 1.7 million people in Scotland

BMJ Open ◽

10.1136/bmjopen-2020-037011 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037011

Author(s):

Christine Campbell ◽

Anne Douglas ◽

Linda Williams ◽

Geneviève Cezard ◽

David H Brewster ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Ethnic Group ◽

Colorectal Cancer Screening ◽

South Asian ◽

Bowel Cancer ◽

Index Number ◽

Adjusted Risk ◽

Targeted Interventions ◽

Bowel Cancer Screening

ObjectiveCancer screening should be equitably accessed by all populations. Uptake of colorectal cancer screening was examined using the Scottish Health and Ethnicity Linkage Study that links the Scottish Census 2001 to health data by individual-level self-reported ethnicity and religion.SettingData on 1.7 million individuals in two rounds of the Scottish Bowel Cancer Screening Programme (2007–2013) were linked to the 2001 Census using the Scottish Community Health Index number.Main outcome measureUptake of colorectal cancer screening, reported as age-adjusted risk ratios (RRs) by ethnic group and religion were calculated for men and women with 95% CI.ResultsIn the first, incidence screening round, compared with white Scottish men, Other White British (RR 109.6, 95% CI 108.8 to 110.3) and Chinese (107.2, 95% CI 102.8 to 111.8) men had higher uptake. In contrast, men of all South Asian groups had lower uptake (Indian RR 80.5, 95% CI 76.1 to 85.1; Pakistani RR 65.9, 95% CI 62.7 to 69.3; Bangladeshi RR 76.6, 95% CI 63.9 to 91.9; Other South Asian RR 88.6, 95% CI 81.8 to 96.1). Comparable patterns were seen among women in all ethnic groups, for example, Pakistani (RR 55.5, 95% CI 52.5 to 58.8). Variation in uptake was also observed by religion, with lower rates among Hindu (RR (95%CI): 78.4 (71.8 to 85.6)), Muslim (69.5 (66.7 to 72.3)) and Sikh (73.4 (67.1 to 80.3)) men compared with the reference population (Church of Scotland), with similar variation among women: lower rates were also seen among those who reported being Jewish, Roman Catholic or with no religion.ConclusionsThere are important variations in uptake of bowel cancer screening by ethnic group and religion in Scotland, for both sexes, that require further research and targeted interventions.

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