Australia-wide cross-sectional survey of general practitioners' knowledge and practice of lung cancer screening.
general practice
lung neoplasm
mass screening
primary care
survey
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
06
03
2020
received:
30
12
2019
accepted:
14
03
2020
pubmed:
3
4
2020
medline:
10
8
2021
entrez:
3
4
2020
Statut:
ppublish
Résumé
Low-dose computed tomography (LDCT) screening can reduce lung cancer deaths in high-risk individuals, yet current Australian guidelines do not recommend screening. Little is known about current screening practices in Australia. To evaluate the proportion of general practitioners who report ordering lung cancer screening for their patients, identify factors associated with ordering lung cancer screening and assess general practitioners (GP) rationale for recommending screening and preference of composition of any future national targeted screening programme. A survey was distributed to a nationally representative sample of 4000 Australian GP. The questionnaire included respondent demographics, self-reported screening practices, knowledge of screening recommendations, recent screening education, preference for recruitment methodologies for potential screening programmes and potential factors influencing the screening practices of GP. Two logistic regression models identified factors associated with self-reported chest X-ray (CXR) and LDCT screening within the past 12 months. A total of 323 GP completed the survey (participation rate 8.1%). Participants were mostly females (50.6%), from collective/group (79.1%) and metropolitan-based practices (73.5%). Despite the majority of responders understanding that screening is not recommended by Australian professional societies (71.2%), a substantial proportion of participants requested a CXR or LDCT screening (46.4% and 20.8% respectively). A variety of shared (GP reassurance, affordability of screening, believing screening is funded) and unique practice, educational and cognitive factors were associated with self-reported LDCT and CXR screening, with the strongest association being recent education about screening from radiology practices (odds ratio (aOR) for LDCT screening 10.4, P < 0.001). In Australia, lung cancer screening occurs outside a coordinated programme, and there is discordance between practice and national recommendations. This highlights an urgent need for clearer guidance from national and professional bodies.
Sections du résumé
BACKGROUND
Low-dose computed tomography (LDCT) screening can reduce lung cancer deaths in high-risk individuals, yet current Australian guidelines do not recommend screening. Little is known about current screening practices in Australia.
AIM
To evaluate the proportion of general practitioners who report ordering lung cancer screening for their patients, identify factors associated with ordering lung cancer screening and assess general practitioners (GP) rationale for recommending screening and preference of composition of any future national targeted screening programme.
METHODS
A survey was distributed to a nationally representative sample of 4000 Australian GP. The questionnaire included respondent demographics, self-reported screening practices, knowledge of screening recommendations, recent screening education, preference for recruitment methodologies for potential screening programmes and potential factors influencing the screening practices of GP. Two logistic regression models identified factors associated with self-reported chest X-ray (CXR) and LDCT screening within the past 12 months.
RESULTS
A total of 323 GP completed the survey (participation rate 8.1%). Participants were mostly females (50.6%), from collective/group (79.1%) and metropolitan-based practices (73.5%). Despite the majority of responders understanding that screening is not recommended by Australian professional societies (71.2%), a substantial proportion of participants requested a CXR or LDCT screening (46.4% and 20.8% respectively). A variety of shared (GP reassurance, affordability of screening, believing screening is funded) and unique practice, educational and cognitive factors were associated with self-reported LDCT and CXR screening, with the strongest association being recent education about screening from radiology practices (odds ratio (aOR) for LDCT screening 10.4, P < 0.001).
CONCLUSION
In Australia, lung cancer screening occurs outside a coordinated programme, and there is discordance between practice and national recommendations. This highlights an urgent need for clearer guidance from national and professional bodies.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1111-1116Informations de copyright
© 2020 Royal Australasian College of Physicians.
Références
Australian Bureau of Statistics (ABS). Causes of Death, Australia, 2015. Canberra: ABS; 2017.
Walters S, Maringe C, Coleman MP, Peake MD, Butler J, Young N et al. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004-2007. Thorax 2013; 68: 551-64.
Marshall HM, Bowman RV, Crossin J, Lau MA, Slaughter RE, Passmore LH et al. Queensland Lung Cancer Screening Study: rationale, design and methods. Intern Med J 2013; 43: 174-82.
Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The eighth edition lung cancer stage classification. Chest 2017; 151: 193-203.
Manser RL, Irving LB, Stone C, Byrnes G, Abramson M, Campbell D. Screening for lung cancer. Cochrane Database Syst Rev 2001; CD001991.
National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365: 395-409.
de Koning HJ, van der Aalst CM, de Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med 2020; 382: 503-13.
Canadian Task Force on Preventative Health Care. CTFPHC Guidelines: Lung Cancer. 2016 [cited 2019 Jun 8]. Available from URL: https://canadiantaskforce.ca/new-lung-cancer-screening-guideline/
Royal Australian College of General Practitioners (RACGP). Guidelines for Preventative Activities in General Practice, 8th edition. Melbourne: RACGP; 2012 [cited 2019 Jun 8]. Available from URL: http://www.racgp.org.au/download/Documents/Guidelines/Redbook8/redbook8.pdf
Federal Department of Health Standing Committee on Screening. Position Statement: Lung Cancer Screening Using Low-Dose Computed Tomography. 2015 [cited 2019 Jun 8]. Available from URL: http://www.cancerscreening.gov.au
Manners D, Wilcox H, McWilliams A, Piccolo F, Liira H, Brims F. Current lung cancer screening practice amongst general practitioners in Western Australia: a cross-sectional study. Intern Med J 2018; 48: 78-80.
Manners DEJ, Brims FJ, Pettigrew S. Lung cancer screening - practical challenges of confining participation to those who might benefit. Aust N Z J Public Health 2016; 40: 205-6.
Australian Government Cancer Australia. National Targeted Lung Cancer Screening Program enquiry launches. 2019 [cited 2019 Jun 8]. Available from URL: https://canceraustralia.gov.au/about-us/news/national-targeted-lung-cancer-screening-program-enquiry-launches
Klabunde CN, Marcus PM, Han PK, Richards TB, Vernon SW, Yuan G et al. Lung cancer screening practices of primary care physicians: results from a national survey. Ann Fam Med 2012; 10: 102-10.
Raz DJ, Wu GX, Consunji M, Nelson R, Sun C, Erhunmwunsee L et al. Perceptions and utilization of lung cancer screening among primary care physicians. J Thorac Oncol 2016; 11: 1856-62.
Duong DK, Shariff-Marco S, Cheng I, Naemi H, Moy LM, Haile R et al. Patient and primary care provider attitudes and adherence towards lung cancer screening at an academic medical center. Prev Med Rep 2017; 6: 17-22.
Sladden MJ, Ward JE. Do Australian family physicians screen smokers for lung cancer? Chest 1999; 115: 725-8.
Wijeratne CEJ, Peisah C, Luscombe GM, Tibbertsma J. Professional and psychosocial factors affecting the intention to retire of Australian medical practitioners. Med J Aust 2017; 206: 209-14.
Royal Australian College of General Practitioners (RACGP). Health of the Nation 2018 Report. Melbourne: RACGP; 2018 [cited 2019 Jun 8]. Available from URL: www.racgp.org.au