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Colorectal cancer risk assessment and screening recommendation: a community survey of healthcare providers' practice from a patient perspective.

ABSTRACT: BACKGROUND: Family history is a common risk factor for colorectal cancer (CRC), yet it is often underused to guide risk assessment and the provision of risk-appropriate CRC screening recommendation. The aim of this study was to identify from a patient perspective health care providers' current practice relating to: (i) assessment of family history of CRC; (ii) notification of "increased risk" to patients at "moderately/potentially high" familial risk; and (iii) recommendation that patients undertake CRC screening. METHODS: 1592 persons aged 56-88 years randomly selected from the Hunter Community Study (HCS), New South Wales, Australia were mailed a questionnaire. 1117 participants (70%) returned a questionnaire. RESULTS: Thirty eight percent of respondents reported ever being asked about their family history of CRC. Ever discussing family history of CRC with a health care provider was significantly more likely to occur for persons with a higher level of education, who had ever received screening advice and with a lower physical component summary score. Fifty one percent of persons at "moderately/potentially high risk" were notified of their "increased risk" of developing CRC. Thirty one percent of persons across each level of risk had ever received CRC screening advice from a health care provider. Screening advice provision was significantly more likely to occur for persons who had ever discussed their family history of CRC with a health care provider and who were at "moderately/potentially high risk". CONCLUSIONS: Effective interventions that integrate both the assessment and notification of familial risk of CRC to the wider population are needed. Systematic and cost-effective mechanisms that facilitate family history collection, risk assessment and provision of screening advice within the primary health care setting are required.

SUBMITTER: Courtney RJ

PROVIDER: S-EPMC3323420 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Colorectal cancer risk assessment and screening recommendation: a community survey of healthcare providers' practice from a patient perspective.

Courtney Ryan J RJ Paul Christine L CL Sanson-Fisher Robert W RW Macrae Finlay A FA Carey Mariko L ML Attia John J McEvoy Mark M

BMC family practice 20120314

<h4>Background</h4>Family history is a common risk factor for colorectal cancer (CRC), yet it is often underused to guide risk assessment and the provision of risk-appropriate CRC screening recommendation. The aim of this study was to identify from a patient perspective health care providers' current practice relating to: (i) assessment of family history of CRC; (ii) notification of "increased risk" to patients at "moderately/potentially high" familial risk; and (iii) recommendation that patient ...[more]

PMID: 22414115

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Project description:BackgroundRecently, there has been growing interest in providing more tailored, patient-centered care for the treatment of type 2 diabetes mellitus (T2DM). Yet it remains unclear which patient characteristics should be determined to guide such an approach. Therefore, the opinions of healthcare providers (HCP) and people with T2DM about relevant patient characteristics for estimating healthcare needs of people with T2DM were assessed and compared.MethodsTwo separate online Delphi studies were conducted according to the RAND-UCLA Appropriateness Method: one with HCPs (n?=?22) from Dutch primary and secondary care and one with people with T2DM treated in Dutch primary care (n?=?46). The relevance of patient characteristics for estimating healthcare needs, defined as the number of yearly consultations, was assessed on a 5-point Likert scale. Characteristics with a median of 4 or 5 and an interquartile range???1.5 were considered relevant with consensus. Participants were also asked to select the top 5 of most relevant patient characteristics. To determine the overall top 5, the mean relative importance score of each characteristic was calculated.ResultsIn two Delphi rounds, 28 and 15 patient characteristics were rated by HCPs and people with T2DM, respectively. Both HCPs and people with T2DM found health-related characteristics relevant for estimating healthcare needs of people with T2DM. However, HCPs preferred to estimate healthcare needs using person- and context-related characteristics. They ranked self-efficacy as the most relevant estimator. In contrast, people with T2DM were more in favor of health-related characteristics and ranked HbA1c as the most relevant estimator.ConclusionsThe findings show that there is discrepancy in opinions on relevant patient characteristics for estimating healthcare needs between HCPs and people with T2DM. To achieve more tailored, patient-centered care, it is important that both groups agree on the topics to be discussed during patient consultations.

Project description:BackgroundZoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses.Methodology/resultsWe conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97%) had heard of brucellosis, 26 (42%) leptospirosis, and 20 (32%) Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4), rabies (4), and anthrax (3) in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%), rabies (9, 18%) and anthrax (6, 12%). None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis.ConclusionsThis study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic capacity alongside healthcare provider education and improved clinical guidelines for syndrome-based disease management to provoke diagnostic consideration of locally relevant zoonoses in the absence of laboratory confirmation.

Project description:Background. Gram negative antibiotic resistance is increasing worldwide as both carbapenem-resistant enterobacteriaceae (CREs) and Enterobacteriaceae producing extended spectrum ß-lactamases (ESBLs) become more common. Objective. We analyzed clinicians' knowledge regarding resistant gram-negative organisms with respect to infection control practices, prescribing practices and assessment of their patients' risk for resistant infections. Design. Online survey. Participants. Target population included clinicians who prescribe antibiotics i.e., medical doctors and mid-level practitioners, at three Massachusetts hospitals. Methods. Questionnaires were sent to 3 Tufts-affiliated teaching hospitals to assess level of knowledge and elucidate perceptions about gram-negative resistance. Results. We received 434 responses from 3332 non-infectious disease clinicians (13%) surveyed at the three hospitals. 51.1% of clinicians correctly scored 50% or greater on the knowledge questions. Internal medicine clinicians had higher knowledge scores than non-internal medicine clinicians (62% vs 45%; OR = 1.67, p = 0.02). Clinicians within three years of training had higher scores than those with more than 10 years of training (64.3% vs 44%; OR = 2.3, p = 0.002). Clinicians with fewer years since training and those with higher knowledge scores were more likely to appropriately consider certain patients at risk for resistant infections (p < 0.05). 54.4% of clinicians were very concerned about gram-negative antibiotic resistance. 64.6% of clinicians felt comfortable de-escalating antibiotics as cultures are available. Conclusion. We found overall low knowledge scores and much variability in the way clinicians assess whether certain patient populations are at risk for antibiotic resistance. Internal medicine clinicians and those with fewer years since completion of their training scored higher and more appropriately considered patients at risk for resistance. The majority of clinicians are concerned about gram-negative resistance and indicated they would de-escalate antibiotic therapy if they had susceptibility information. These results will help focus and target our teaching and awareness-raising strategies.

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Dataset Information

Colorectal cancer risk assessment and screening recommendation: a community survey of healthcare providers' practice from a patient perspective.

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Colorectal cancer risk assessment and screening recommendation: a community survey of healthcare providers' practice from a patient perspective.

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