title: General practitioner management related to skin cancer prevention and screening during standard medical encounters: a French cross-sectional study based on the International Classification of Primary Care.
abstract: The aim of this study was to assess general practitioner (GP) management practices related to skin cancer prevention and screening during standard medical encounters.
  
  
  
  Data on medical encounters addressing skin cancer issues were obtained from a French database containing information from 17 019 standard primary care consultations.
  
  
  
  Data were collected between December 2011 and April 2012 by 54 trainees who reported the regular practice of 128 GPs using the International Classification of Primary Care.
  
  
  
  Reasons for encounters and the following care processes were recorded: counselling, clinical examinations and referral to a specialist. Medical encounters addressing skin cancer issues were compared with medical encounters that addressed other health problems using a multivariate analysis.
  
  
  
  Only 0.7% of medical encounters addressed skin cancer issues. When patients did require management of a skin cancer-related issue, this was more likely initiated by the doctor than the patient (70.7% vs 29.3%; p<0.001). Compared with medical encounters addressing other health problems, encounters that addressed skin cancer problems required more tasks (3.7 vs 2.5; p<0.001) and lasted 1 min and 20 s longer (p=0.003). GPs were less involved in clinical examinations (67.5% vs 97.1%; p<0.001), both complete (7.3% vs 22.3%, p<0.001) and partial examinations (60.2% vs 74.9%), and were less involved in counselling (5.7% vs 16.9%; p<0.001). Patients presenting skin cancer issues were referred to a specialist more often than patients consulting for other health problems (39.0% vs 12.1%; p<0.001). GPs performed a biopsy in 6.7% of all skin cancer-related encounters.
  
  
  
  This study demonstrates discrepancies between the high prevalence of skin cancer and the low rate of medical encounters addressing these issues in general practice. Our findings should be followed by qualitative interviews to better understand the observed practices in this field.
authors.affiliation: Faculty of Medicine of Nantes, Department of General Practice, Nantes, France.|INSERM U1232, Nantes, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Rat
authors.affiliation: Faculty of Medicine of Nantes, Department of General Practice, Nantes, France.
authors.forename: Sara
authors.initials: S
authors.lastname: Houd
authors.affiliation: Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Gaultier
authors.affiliation: Faculty of Medicine of Nantes, Department of General Practice, Nantes, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Grimault
authors.affiliation: INSERM U1232, Nantes, France.|Oncodermatology Department, Nantes University Hospital, Nantes, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Quereux
authors.affiliation: Faculty of Medicine of Paris 13, Department of General Practice, Bobigny, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Mercier
authors.affiliation: Department of General Practice, University Claude Bernard Lyon 1, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Letrilliart
authors.affiliation: INSERM U1232, Nantes, France.|Oncodermatology Department, Nantes University Hospital, Nantes, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Dreno
authors.affiliation: INSERM U1232, Nantes, France.|Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France.
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D037001:Directive Counseling / Q000706:statistics & numerical data; D055088:Early Detection of Cancer; D005260:Female; D005602:France; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010808:Physical Examination / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055815:Young Adult
keywords: Early detection of cancer; Prevention; Primary healthcare; Screening; Skin cancer