title: General practitioners' perceptions of population based bowel screening and their influence on practice: a qualitative study.
abstract: BACKGROUND
  Although largely preventable, Australia has one of the highest rates of bowel cancer in the world. General Practitioners (GPs) have an important role to play in prevention and early detection of bowel cancer, however in Australia this is yet to be optimised and participation remains low. This study sought to understand how GPs' perceptions of bowel screening influence their attitudes to, and promotion of the faecal occult blood test (FOBT), to identify opportunities to enhance their role.
  
  
  METHODS
  Interviews were conducted with 31 GPs from metropolitan and regional New South Wales (NSW), Australia. Discussions canvassed GPs' perceptions of their role in bowel screening and the national screening program; perceptions of screening tests; practices regarding discussing screening with patients; and views on opportunities to enhance their role. Transcripts were coded using Nvivo and thematically analysed.
  
  
  RESULTS
  The study revealed GPs' perceptions of screening did not always align with broader public health definitions of 'population screening'. While many GPs reportedly understood the purpose of population screening, notions of the role of asymptomatic screening for bowel cancer prevention were more limited. Descriptions of screening centred on two major uses: the use of a screening 'process' to identify individual patients at higher risk; and the use of screening 'tools', including the FOBT, to aid diagnosis. While the FOBT was perceived as useful for identifying patients requiring follow up, GPs expressed concerns about its reliability. Colonoscopy by comparison, was considered by many as the gold standard for both screening and diagnosis. This perception reflects a conceptualisation of the screening process and associated tools as an individualised method for risk assessment and diagnosis, rather than a public health strategy for prevention of bowel cancer.
  
  
  CONCLUSIONS
  The results show that GPs' perceptions of screening do not always align with broader public health definitions of 'population screening'. Furthermore, the way GPs understood screening was shown to impact their clinical practice, influencing their preferences for, and use of 'screening' tools such as FOBT. The findings suggest emphasising the preventative opportunity of FOBT screening would be beneficial, as would formally engaging GPs in the promotion of bowel screening.
authors.affiliation: Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, Australia, 2007. greer.dawson@saxinstitute.org.au.|School of Public Health and Community Medicine, Samuels Building, University of New South Wales, Sydney, NSW, Australia, 2052. greer.dawson@saxinstitute.org.au.
authors.forename: Greer
authors.identifier: http://orcid.org/0000-0001-9876-6319
authors.initials: G
authors.lastname: Dawson
authors.affiliation: Prevention Research Collaboration, The Charles Perkins Centre, Level 6, The Hub, School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006.
authors.forename: Melanie
authors.initials: M
authors.lastname: Crane
authors.affiliation: NSW Department of Premier and Cabinet, 52 Martin Place, Sydney, NSW, Australia, 2000.
authors.forename: Claudine
authors.initials: C
authors.lastname: Lyons
authors.affiliation: Cancer Institute NSW, Australian Technology Park, Level 9, 8 Central Avenue, Sydney, NSW, Australia, 2015.
authors.forename: Anna
authors.initials: A
authors.lastname: Burnham
authors.affiliation: Cancer Institute NSW, Australian Technology Park, Level 9, 8 Central Avenue, Sydney, NSW, Australia, 2015.
authors.forename: Tara
authors.initials: T
authors.lastname: Bowman
authors.affiliation: Cancer Institute NSW, Australian Technology Park, Level 9, 8 Central Avenue, Sydney, NSW, Australia, 2015.
authors.forename: Donna
authors.initials: D
authors.lastname: Perez
authors.affiliation: Faculty of Health, University of Technology Sydney, Level 7, 235 Jones Street, Sydney, NSW, Australia, 2007.
authors.forename: Joanne
authors.initials: J
authors.lastname: Travaglia
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D009517:New South Wales; D009780:Occult Blood; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010465:Perception; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research
keywords: Bowel cancer; Bowel screening; Cancer prevention; Early detection; FOBT; General practitioners; Qualitative