ABSTRACT
Using the algorithm of the World Endoscopy Organisation (WEO), we have studied retrospectively all colorectal cancers, both detected and non-detected by the Basque Country screening programme from 2009 to 2017. In the screening programme 61,335 colonoscopies were performed following a positive Faecal Immunochemical test (FIT) (≥20 µg Hb/g faeces) and the 128 cases of post-colonoscopy colorectal cancer (PCCRC) detected were analysed. Among them, 50 interval type PCCRCs were diagnosed (before the recommended surveillance), 0.8 cases per 1000 colonoscopies performed, and 78 non-interval type PCCRCs (in the surveillance carried out at the recommended time or delayed), 1.3 per 1000 colonoscopies. Among the non-interval type PCCRCs, 61 cases were detected in the surveillance carried out at the recommended time (type A) and 17 when the surveillance was delayed (type B), 1 case per 1000 colonoscopies performed and 0.28 cases per 1000 colonoscopies performed, respectively. Interval type PCCRC is less frequent than non-interval type PCCRC. In interval type PCCRCs, CRCs detected in advanced stages (stages III-IV) were significantly more frequent than those detected in early stages, compared to those of non-interval type PCCRCs (OR = 3.057; 95% CI, 1.410-6.625; p < 0.005). Non-interval type B PCCRCs are less frequent than non-interval type A PCCRCs, but the frequency of advanced stages is higher in interval type B PCCRCs.
ABSTRACT
OBJECTIVE: High participation determines the success of colorectal cancer screening programmes in reducing incidence and mortality. The factors that determine participation must be studied from the perspective of professionals that implement the programme. The aim was to identify factors that facilitate or hinder the participation of the invited people in the bowel cancer screening programme of the Basque Country (Spain) from professional's perspective. METHODS: Qualitative design based on individual interviews and focus groups. Thirty-eight primary care professionals who implement the programme participated (administrative staff, nurses and general practitioners). Thematic analysis was performed. RESULTS: Professionals show high satisfaction with the programme, and they believe firmly in its benefits. Facilitators for participation include professionals' commitment to the programme, their previous positive experiences, their optimistic attitude towards the prognosis of cancer and their trust in the health system and accessibility. Barriers include invitees' lack of independence to make decisions, fear of a positive test result and patient vulnerability and labour mobility of the health professionals. CONCLUSIONS: Professionals show a high degree of involvement and identify primary care is an appropriate place to carry out disease prevention. They identify the closeness to patients, the personal attitude and the characteristics of the health system as key factors that influence participation.
Subject(s)
Colorectal Neoplasms , Early Detection of Cancer , Attitude of Health Personnel , Colorectal Neoplasms/diagnosis , Delivery of Health Care , Health Personnel , Humans , Qualitative ResearchABSTRACT
OBJECTIVE: The Basque Government (Spain) approved a population based Colorectal Cancer Screening Programme in 2008 with its base on Primary Healthcare. Since then, a coverage of 100% of the population and an average participation rate of 68.4% have been achieved. General Practitioners and nurses play a central role on its implementation. The aim of this work was to describe the characteristics, involvement and attitudes of the health professionals that implement the programme. METHODS: A cross-sectional descriptive study was conducted in Primary Healthcare to general practitioners and nurses between May and June of 2016. An ad-hoc online questionnaire was designed. The data included socio-demographic information and questions regarding their involvement on the programme. RESULTS: 1,216 health professionals answered the questionnaire, 50.7% were general practitioners and 49.3% nurses. 78% of the responders were women. The 75.8% considered the programme very important although differences were found between general practitioners and nurses. The 89% of the professionals attended training and 34% scientific workshops about screening at least once. There were differences between general practitioners and nurses on the attendance to the training and importance they give to the programme, and on their participation on workshops. CONCLUSIONS: There is a high level of involvement of Primary Healthcare professionals in the programme as they consider it very important; this could be one of the keys for its success. The differences between professionals on their opinion and experience should be taken into account on its design, as they are the ones with a closer contact with the population.
OBJETIVO: El Gobierno Vasco (España) aprobó en 2008 un programa de detección del cáncer colorrectal de base poblacional en Atención Primaria. Se ha logrado una cobertura del 100% con una tasa de participación media del 68,4%. Los profesionales de medicina y enfermería desempeñan un papel fundamental en su implementación. El objetivo fue describir las características, implicación y actitudes de los profesionales de la salud que implementan el programa. METODOS: Estudio descriptivo transversal a personal de medicina y enfermería entre mayo y junio de 2016. Se diseñó un cuestionario en línea ad-hoc. Los datos incluían información sociodemográfica y preguntas relativas a su implicación en el programa. RESULTADOS: 1.216 profesionales de la salud respondieron al cuestionario (50,7% medicina y 49,3% enfermería). El 78% eran mujeres. El 75,8% consideró que el programa era muy importante, aunque se encontraron diferencias entre profesionales de medicina y de enfermería. El 89% asistió a formación y el 34% a jornadas científicas sobre el cribado por lo menos una vez. Se observaron diferencias entre médicos y profesionales de la enfermería en cuanto a la asistencia a formación y jornadas y en la importancia que daban al programa. CONCLUSIONES: Existe un alto nivel de participación de los profesionales de la atención primaria de la salud en el programa y lo consideran muy importante. Las diferencias entre los profesionales en cuanto a su opinión y experiencia deben ser tenidas en cuenta en el diseño de los programas, ya que son ellos los que tienen un contacto más estrecho con la población.
Subject(s)
Colorectal Neoplasms/diagnosis , Early Detection of Cancer , Primary Health Care/organization & administration , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Program Evaluation , SpainABSTRACT
BACKGROUND: Colorectal cancer (CRC) screening programmes require high levels of participation in order to reduce mortality. To improve participation rates, it is necessary to identify the health risk factors and social inequalities associated with non-participation. METHODS: A systematic review was conducted between June and September of 2019 in six databases: CINHAL, Medline, Scopus, Social Sciences Citation Index, Embase and PsycINFO. Studies assessing the relationship between health risk factors, participation in preventive activities and participation in CRC screening were included. Methodological assessment was carried out according to the Quality Assessment Tools of the National Heart, Lung and Blood Institute. RESULTS: A total of nine studies that analyze participation in both organized and opportunistic screening programmes using any type of screening method were finally selected. Data were mainly self-reported although in two studies medical records were also studied. We identified several variables: gender, body mass index, consultation with a doctor or a specialist, educational level, employment, health insurance, residence, ethnicity, age, marital status, income, other preventive activities, obesity, physical activity, smoking, family history of CRC and general health status. CONCLUSION: The scarcity of studies linking risk factors, social inequalities and participation in preventive activities for participation in screening in the same study makes it difficult to reach definitive patterns related to non-participation in CRC screening programmes. Nevertheless, being under 60, obese, smoker and sedentary have shown an association with non-participation as well as not visiting a doctor.
