The Newfoundland and Labrador colorectal cancer screening program for the average risk population: A pre-implementation study of the family physician and target population perspective on fecal occult blood testing.

McCrate, Farah R. (2016) The Newfoundland and Labrador colorectal cancer screening program for the average risk population: A pre-implementation study of the family physician and target population perspective on fecal occult blood testing. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Background Newfoundland and Labrador (NL) has the highest incidence and mortality rates of colorectal cancer (CRC) in North America. In March 2010, funding was announced for a fecal occult blood test (FOBT) screening program for those aged 50 – 74 years and at average risk for CRC. The main goal of this program is to reduce mortality from CRC through the detection of pre-cancerous polyps or early-stage cancer. Research was undertaken prior to program implementation to survey the average risk population regarding their intention to participate in screening and to ascertain family physicians’ knowledge of screening guidelines, current screening practices and level of support for an organized screening program. Methods Average risk individuals living in three different areas of the province were surveyed (n = 959): a rural area with a familial cluster of high genetic risk CRC, and a rural and an urban area without familial clusters of high genetic risk CRC. It was hypothesized that those living in the area with a presence of high genetic risk CRC would be most likely to report positive intention to participate in screening. It was further hypothesized that between the two areas without any familial clustering of CRC, urban respondents would be more likely to report a positive intention to screen. The intent of the family physician survey (n = 274) was to enhance understanding of FOBT screening practices and level of physician support for an organized screening program. It was posited that the majority of physicians would be supportive of an organized FOBT screening program but would not necessarily be screening their average risk patients according to recommended guidelines. Results No significant association was found between intention to screen and a) presence of a familial cluster of high genetic risk CRC (p = 0.17), or b) residing in a rural versus urban region (p = 0.30). In multivariate analysis, prior awareness of FOBT [OR = 1.92, 95% CI 1.32 – 2.77, p = 0.001] and prior use of FOBT [OR = 1.87, 95% CI 1.18 – 2.97, p = 0.008] were significant predictors of positive screening intention. Almost all family physicians indicated support for an organized screening program (n = 256, 94.8%). Despite this, colonoscopy was the most commonly recommended procedure for screening average risk patients. Most physicians were compliant with the guideline- recommended age to start screening, (n = 228, 83.5%), but fewer were compliant with the recommended age for stopping (n = 66, 25%). Conclusions Presence of a familial cluster of high genetic risk CRC did not appear to positively impact the screening intention of average risk individuals. Based on previous research, a higher than expected level of positive intention to screen was reported across all regions that were sampled. Similarly, it was unanticipated that almost all family physicians would be supportive of an organized screening program. Follow-up research, post-implementation of the screening program, will provide an opportunity to determine whether reported intention and support translate into high rates of participation and physician referral for screening.

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