Bowel cancer screening in England: a qualitative study of GPs' attitudes and information needs

BACKGROUND: The National Health Service Bowel Cancer Screening Programme is to be introduced in England during 2006. General Practitioners are a potentially important point of contact for participants throughout the screening process. The aims of the study were to examine GPs' attitudes and information needs with regard to bowel cancer screening, with a view to developing an information pack for primary care teams that will be circulated prior to the introduction of the programme. METHODS: 32 GPs participated in semi-structured telephone interviews. 18 of these had participated in the English Bowel Screening Pilot, and 14 had not. Interviews covered attitudes towards the introduction of the Bowel Cancer Screening Programme, expected or actual increases in workload, confidence in promoting informed choice, and preferences for receiving information about the programme. RESULTS: GPs in the study were generally positive about the introduction of the Bowel Cancer Screening Programme. A number of concerns were identified by GPs who had not taken part in the pilot programme, particularly relating to patient welfare, patient participation, and increased workload. GPs who had taken part in the pilot reported holding similar concerns prior to their involvement. However, in many cases these concerns were not confirmed through GPs experiences with the pilot. A number of specific information needs were identified by GPs to enable them to provide a supportive role to participants in the programme. CONCLUSION: The study has found considerable GP support for the introduction of the new Bowel Cancer Screening Programme. Nonetheless, GPs hold some significant reservations regarding the programme. It is important that the information needs of GPs and other members of the primary care team are addressed prior to the roll-out of the programme so they are equipped to promote informed choice and provide support to patients who consult them with queries regarding screening

Attitudes to colorectal cancer screening among ethnic minority groups in the UK

Background: Colorectal screening by Flexible Sigmoidoscopy (FS) is under evaluation in the UK. Evidence from existing cancer screening programmes indicates lower participation among minority ethnic groups than the white-British population. To ensure equality of access, it is important to understand attitudes towards screening in all ethnic groups so that barriers to screening acceptance can be addressed.Methods: Open- and closed-ended questions on knowledge about colorectal cancer and attitudes to FS screening were added to Ethnibus (TM) - a monthly, nationwide survey of the main ethnic minority communities living in the UK (Indian, Pakistani, Bangladeshi, Caribbean, African, and Chinese). Interviews (n = 875) were conducted, face-to-face, by multilingual field-workers, including 125 interviews with white-British adults.Results: All respondents showed a notable lack of knowledge about causes of colorectal cancer, which was more pronounced in ethnic minority than white-British adults. Interest in FS screening was uniformly high (> 60%), with more than 90% of those interested saying it would provide 'peace of mind'. The most frequently cited barrier to screening 'in your community' was embarrassment, particularly among ethnic minority groups.Conclusion: Educational materials should recognise that non-white groups may be less knowledgeable about colorectal cancer. The findings of the current study suggest that embarrassment may be a greater deterrent to participation to FS screening among ethnic minority groups, but this result requires exploration in further research

Public perceptions of communicating information about bowel cancer screening

OBJECTIVES: The National Health Service has recently begun the introduction of a Bowel Cancer Screening Programme (BCSP), offering biennial screening to men and women aged 60-69 years. This study aimed to explore public perceptions regarding the communication of information designed to facilitate informed choice in relation to this new screening programme.METHODS: Fourteen single sex focus groups were conducted in England with 86 individuals aged 60-69 years. Focus groups were conducted either with individuals who had participated in the pilot phase of the BCSP, or with members of the public living outside the pilot areas. RESULTS: The majority of participants expressed positive attitudes towards bowel cancer screening, identifying items highlighting the benefits of the programme as important for others to know. Whilst some believed it was appropriate for information regarding the potentially negative aspects of the programme to be communicated at the outset, others expressed concerns about the generation of anxiety and potential for decreased participation. A number of participants questioned the concept of informed choice, arguing that once in place, a screening programme should be vigorously promoted. CONCLUSIONS: There is some variation in the type of information favoured by those eligible for bowel cancer screening. This may present challenges for the provision of information aiming to facilitate informed choice in the BCSP. Flexible approaches to information provision that recognize the perceptions of patients may be required

Public perceptions of communicating information about bowel cancer screening

OBJECTIVES: The National Health Service has recently begun the introduction of a Bowel Cancer Screening Programme (BCSP), offering biennial screening to men and women aged 60-69 years. This study aimed to explore public perceptions regarding the communication of information designed to facilitate informed choice in relation to this new screening programme.METHODS: Fourteen single sex focus groups were conducted in England with 86 individuals aged 60-69 years. Focus groups were conducted either with individuals who had participated in the pilot phase of the BCSP, or with members of the public living outside the pilot areas. RESULTS: The majority of participants expressed positive attitudes towards bowel cancer screening, identifying items highlighting the benefits of the programme as important for others to know. Whilst some believed it was appropriate for information regarding the potentially negative aspects of the programme to be communicated at the outset, others expressed concerns about the generation of anxiety and potential for decreased participation. A number of participants questioned the concept of informed choice, arguing that once in place, a screening programme should be vigorously promoted. CONCLUSIONS: There is some variation in the type of information favoured by those eligible for bowel cancer screening. This may present challenges for the provision of information aiming to facilitate informed choice in the BCSP. Flexible approaches to information provision that recognize the perceptions of patients may be required