title: Obstacles to colorectal screening in general practice: a qualitative study of GPs and patients.
abstract: BACKGROUND
  The faecal occult blood test (FOBT) has proven efficiency at screening populations for an average risk of colorectal cancer. Mortality related to this cancer decreases by 15-18% among adults, 50-74 years old, tested every 2 years. A participation rate of at least 50% is desirable. This rate has not yet been reached in most French regions.
  
  
  OBJECTIVE
  To explore the obstacles to mass colorectal screening in France.
  
  
  METHODS
  In 2009, five focus groups were conducted in different areas to explore physicians' obstacles to FOBT screening. The patients' obstacles were assessed in semi-structured interviews. A purposive sampling had been carried out for both GPs and patients. The focus groups were coded using Nvivo 8(®) software by three researchers; the interviews manually coded by two researchers.
  
  
  RESULTS
  GPs reported insufficient training and some doubted the relevance of screening. They expressed concern of having insufficient time for the test during a consultation, as well as practical and administrative obstacles. Some GPs experienced difficulty persuading patients who had no signs of colorectal disease. Obstacles for patients were mainly difficulties in doing screening themselves and a perception of health care that didn't match with screening. Information and organization were also important points to improve. The screening process was considered complex both by GPs and by patients.
  
  
  CONCLUSIONS
  Numerous obstacles to colorectal screening, from both the physicians' and the patients' perspectives, were found. The major goal to improve mass screening may be to increase awareness and understanding of both physicians and patients regarding this process.
authors.affiliation: Département de médecine générale, Denis Diderot University Paris 7, 16 rue Henri, Huchard 75018, Paris, France. isabelle.aubinauger@sfr.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Aubin-Auger
authors.forename: Alain
authors.initials: A
authors.lastname: Mercier
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lebeau
authors.forename: Laurence
authors.initials: L
authors.lastname: Baumann
authors.forename: Lieve
authors.initials: L
authors.lastname: Peremans
authors.forename: Paul
authors.initials: P
authors.lastname: Van Royen
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D005188:False Negative Reactions; D005260:Female; D017144:Focus Groups; D005602:France; D058006:General Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D013997:Time Factors