GPs’ perspectives on colorectal cancer screening and their potential influence on FIT-positive patients: an exploratory qualitative study from a Dutch context

• Main Authors: Lucinda Bertels, Sientje van der Heijden, Maartje Hoogsteyns, Evelien Dekker, Kristel van Asselt, Henk van Weert, Bart Knottnerus
• Format: Article
• Language: English
• Published: Royal College of General Practitioners 2019-03-01
• Series: BJGP Open
• Subjects: Primary Health Care; Family Practice; Colorectal Neoplasms; Early Detection of Cancer; Colorectal Cancer Screening; Qualitative Research
• Online Access: https://bjgpopen.org/content/3/1/bjgpopen18X101631

Background: In the Dutch colorectal cancer (CRC) screening programme, individuals receive a faecal immunochemical test (FIT) to do at home. After a positive FIT result, a follow-up colonoscopy is recommended to identify CRC or advanced adenomas (AA). GPs may influence their patients’ decisions on adherence to follow-up by colonoscopy. Aim: To explore GPs’ perspectives on the CRC screening programme and their potential influence on FIT-positive patients to follow up with the recommended colonoscopy. Design & setting: Semi-structured interviews among GPs in Amsterdam, the Netherlands. Method: GPs were approached using purposive sampling. Analysis was performed on 11 interviews using open coding and constant comparison. Results: All interviewed GPs would recommend FIT-positive patients without obvious contraindications to adhere to a follow-up colonoscopy. If patients were likely to be distressed by a positive FIT result, most GPs described using reassurance strategies emphasising a low cancer probability. Most GPs stressed the probability of false-positive FIT results. Some described taking a positive screening result in CRC screening less seriously than one in breast cancer screening. Most GPs underestimated CRC and AA probabilities after a positive FIT result. When told the actual probabilities, some stated that this knowledge might change the way they would inform patients. Conclusion: These results imply that some of the interviewed GPs have too low a perception of the risk associated with a positive FIT result, which might influence their patients’ decision-making. Simply informing GPs about the actual rates of CRC and AA found in the screening programme might improve this risk perception.