GPs key in detecting bowel cancer sooner

Matt Woodley

3/07/2020 3:16:43 PM

Increasing the role of GPs in the screening process could improve the number of test completions, a new study has found.

Screening kit
Fear of the test process and the potential embarrassment in dealing with faeces are major blocks to raising participation rates. (Image: AAP)

The research, conducted by Flinders University, quizzed people about their experiences with the Australian Government’s National Bowel Cancer Screening Program (NBCSP), which only has a 41% completion rate.
According to the survey, men younger than 70 – who have the lowest rates of use – fear the test process and potential embarrassment in dealing with faeces. However, they suggest increasing the role of GPs in the screening process could help overcome these anxieties and improve the number of test completions.
‘The findings from this study reinforced the important role that GPs can play in supporting the uptake of the NBCSP in Australia,’ the study authors wrote.
‘This finding is consistent with evidence from our earlier research and other studies illustrating that GPs could offer support with education, advice, monitoring and active screening.
‘The need to improve this situation is urgent. Bowel cancer is the third most commonly diagnosed cancer in Australia and second most frequent cause of death from cancer, although up to 90% of deaths from bowel cancer are preventable with early detection.’
Participants in the study were taken from three general practices in low socioeconomic areas of metropolitan Adelaide. They said GPs would be able to support a better uptake of NBCSP kits, as they have a patient’s trust, respect, confidence, familiarity, expertise and accountability, as well as the added benefit of providing a personal touch.
Professor John Emery, GP and Herman Professor of Primary Care Cancer Research at the University of Melbourne, previously told newsGP participation rates are ‘far from ideal’, but agrees GPs are in a position to help.
‘There’s continuing evidence that this is an effective program at diagnosing bowel cancer early and improving survival rates,’ he said. ‘[So] the big issues, really, are around how we increase participation.
‘GPs are key to discussions around cancer screening, to promoting both informed choices in … screening and increased participation, particularly in the NBCSP.’
According to the survey, GPs can help by presenting patients with information about bowel cancer risks and the screening process before, at the time of testing, and following a screen by providing kits to people monitoring and sending reminders, and collecting kits.
This suggests support for an individualised approach that differs from the NBCSP’s current population-level method that sends kits to people’s homes by post.
‘Given current burdens on general practice, GP involvement should be just one component of a much larger strategy that targets screening at different levels,’ Dr Lynsey Brown, lead author of the study, said.
Other suggested community-based solutions include:

  • reducing fear of the test process
  • training younger generations about the necessity and value of testing
  • enabling informed decision-making
  • decreasing the stigma of faeces testing and making information widely available.
Strategies to enhance the acceptance of screening in Australia also include school-based programs that would not only educate young people so they are prepared for screening later in life, but also have them encourage parents and grandparents to participate.
‘Bowel cancer screening is different to other forms of screening as the responsibility is currently placed on the individual to decide whether to take part,’ Professor Richard Reed, from Flinders University’s College of Medicine and Public Health, said.
The likelihood of people completing a screening kit was influenced by factors such as having past experiences with cancer, their gratitude for the free program, recognising the value of screening, accepting the advice from others, and prioritising their healthcare – while females and older people were also more likely to complete the screening test.
Barriers were related to limited community support for screening, a lack of urgency when the kit arrived in the mail, and traditional upbringing in which bodily functions were not discussed, as well as fear and the nature of the testing process.
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