Efficacy of communication skills training on colorectal cancer screening by GPs: a cluster randomised controlled trial
Corresponding Author
I. Aubin-Auger MD, PhD
Professor
Département de Médecine Générale, Université Paris Diderot, Sorbonne Paris Cité, Paris
EA Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (REMES), Paris
Correspondence address: Isabelle Aubin-Auger, 40 rue Carnot, 95230 Soisy sous Montmorency, France (e-mail: [email protected]).Search for more papers by this authorC. Laouénan MD, PhD
Doctor
IAME, UMR 1137, INSERM, Paris
Université Paris Diderot, Sorbonne Paris Cité, Paris
AP-HP, Hôpital Bichat, Service de Biostatistique, Paris
Search for more papers by this authorJ. Le Bel MD
Doctor
Département de Médecine Générale, Université Paris Diderot, Sorbonne Paris Cité, Paris
IAME, UMR 1137, INSERM, Paris
Université Paris Diderot, Sorbonne Paris Cité, Paris
Search for more papers by this authorA. Mercier MD, PhD
Professor
Département de Médecine Générale, Rouen University, Rouen
Search for more papers by this authorD. Baruch MD
Doctor
Département de Médecine Générale, Université Paris Diderot, Sorbonne Paris Cité, Paris
EA Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (REMES), Paris
Search for more papers by this authorJ.P. Lebeau MD
Professor
Département de Médecine Générale, Tours University, Tours
Search for more papers by this authorA. Youssefian MD
Doctor
Département de Médecine Générale, Université Paris Diderot, Sorbonne Paris Cité, Paris
Search for more papers by this authorT. Le Trung MD
Doctor
Prévention Santé Val d'Oise, Cergy Saint Christophe, France
Search for more papers by this authorL. Peremans MD, PhD
Professor
Department of Public Health, Vrije Universiteit Brussel, Brussels
Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Search for more papers by this authorP. Van Royen MD, PhD
Professor
Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Search for more papers by this authorCorresponding Author
I. Aubin-Auger MD, PhD
Professor
Département de Médecine Générale, Université Paris Diderot, Sorbonne Paris Cité, Paris
EA Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (REMES), Paris
Correspondence address: Isabelle Aubin-Auger, 40 rue Carnot, 95230 Soisy sous Montmorency, France (e-mail: [email protected]).Search for more papers by this authorC. Laouénan MD, PhD
Doctor
IAME, UMR 1137, INSERM, Paris
Université Paris Diderot, Sorbonne Paris Cité, Paris
AP-HP, Hôpital Bichat, Service de Biostatistique, Paris
Search for more papers by this authorJ. Le Bel MD
Doctor
Département de Médecine Générale, Université Paris Diderot, Sorbonne Paris Cité, Paris
IAME, UMR 1137, INSERM, Paris
Université Paris Diderot, Sorbonne Paris Cité, Paris
Search for more papers by this authorA. Mercier MD, PhD
Professor
Département de Médecine Générale, Rouen University, Rouen
Search for more papers by this authorD. Baruch MD
Doctor
Département de Médecine Générale, Université Paris Diderot, Sorbonne Paris Cité, Paris
EA Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (REMES), Paris
Search for more papers by this authorJ.P. Lebeau MD
Professor
Département de Médecine Générale, Tours University, Tours
Search for more papers by this authorA. Youssefian MD
Doctor
Département de Médecine Générale, Université Paris Diderot, Sorbonne Paris Cité, Paris
Search for more papers by this authorT. Le Trung MD
Doctor
Prévention Santé Val d'Oise, Cergy Saint Christophe, France
Search for more papers by this authorL. Peremans MD, PhD
Professor
Department of Public Health, Vrije Universiteit Brussel, Brussels
Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Search for more papers by this authorP. Van Royen MD, PhD
Professor
Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Search for more papers by this authorAbstract
Colorectal cancer (CRC) mass screening has been implemented in France since 2008. Participation rates remain too low. The objective of this study was to test if the implementation of a training course focused on communication skills among general practitioners (GP) would increase the delivery of gaiac faecal occult blood test and CRC screening participation among the target population of each participating GP. A cluster randomised controlled trial was conducted with GP's practice as a cluster unit. GPs from practices in the control group were asked to continue their usual care. GPs of the intervention group received a 4-h educational training, built with previous qualitative data on CRC screening focusing on doctor–patient communication with a follow-up of 7 months for both groups. The primary outcome measure was the patients' participation rate in the target population for each GP. Seventeen GPs (16 practices) in intervention group and 28 GPs (19 practices) in control group participated. The patients' participation rate in the intervention group were 36.7% vs. 24.5% in the control group (P = 0.03). Doctor–patient communication should be developed and appear to be one of the possible targets of improvement patients adherence and participation rate in the target population for CRC mass screening.
References
- Aubin-Auger I., Mercier A., Lebeau J.P., Baumann L., Peremans L. & van Royen P. (2011) Obstacles to colorectal screening in general practice: a qualitative study of GPs and patients. Family Practice 28, 670–676.
- Aubin-Auger I., Mercier A., Le Bel J., Bombeke K., Baruch D., Youssefian A., Lebeau J.P., Le Trung T., Peremans L. & van Royen P. (2013a) From qualitative data to GP training on CRC screening. Journal of Cancer Education 28, 439–443.
- Aubin-Auger I., Mercier A., Mignotte K., Lebeau J.-P., Bismuth M., Peremans L. & van Royen P. (2013b) Delivering the faecal occult blood test: more instructions than shared decisions. A qualitative study among French GPs. The European Journal of General Practice 19, 150–157.
- Austoker J., Giordano L., Hewitson P. & Villain P. (2012) European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition–Communication. Endoscopy 44(Suppl. 3), SE164–SE185.
- Berkhof M., van Rijssen H.J., Schellart A.J., Anema J.R. & van der Beek A.J. (2011) Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. Patient Education and Counseling 84, 152–162.
- Le Breton J., Journy N., Attali C., Le Corvoisier P., Brixi Z., Bastuji-Garin S. & Chevreul K. (2012) Improving participation in colorectal cancer screening: targets for action. Preventive Medicine 55, 488–492.
- Cals J.W., Butler C.C., Hopstaken R.M., Hood K. & Dinant G.J. (2009) Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. British Medical Journal 338, b1374.
- Campbell M.K., Fayers P.M. & Grimshaw J.M. (2005) Determinants of the intracluster correlation coefficient in cluster randomized trials: the case of implementation research. Clinical Trials 2, 99–107.
- Eldridge S.M., Ashby D. & Kerry S. (2006) Sample size for cluster randomized trials: effect of coefficient of variation of cluster size and analysis method. International Journal of Epidemiology 35, 1292–1300.
- Gimeno Garcia A.Z. (2012) Factors influencing colorectal cancer screening participation. Gastroenterology Research and Practice 2012, 483417 doi: 10.1155/2012/483417
- Giraudeau B. & Ravaud P. (2009) Preventing bias in cluster randomised trials. PLoS Medicine 6, e1000065.
- Goulard H., Boussac-Zarebska M., Ancelle-Park R. & Bloch J. (2008) French colorectal cancer screening pilot programme: results of the first round. Journal of Medical Screening 15, 143–148.
- HAS (2004) Indications for lower gastrointestinal endoscopy (excluding population screening). Available at: http://www.has-sante.fr/portail/upload/docs/application/pdf/Endoscopy_guidelines.pdf (accessed 5 January 2013).
- Huang C.S., Lal S.K. & Farraye F.A. (2005) Colorectal cancer screening in average risk individuals. Cancer Causes and Control 16, 171–188.
- InVS (2013) Taux de participation au programme de dépistage organisé du cancer colorectal 2011-2012. Available at: http://www.invs.sante.fr/Dossiers-thematiques/Maladies-chroniques-et-traumatismes/Cancers/Evaluation-des-programmes-de-depistage-des-cancers/Evaluation-du-programme-de-depistage-du-cancer-colorectal/Indicateurs-d-evaluation/Taux-de-participation-au-programme-de-depistage-organise-du-cancer-colorectal-2011-2012 (accessed 5 January 2013).
- Launoy G., Herbert C., Vallée J.P., Desoubeaux N., Réaud J.M., Ollivier V., Bouvier V., Flachs A., Arsène D., Valla A. & Gignoux M. (1996) Mass screening for colorectal cancer in France. Experience in 165,000 people in the department of Calvados. Gastroentérologie Clinique Et Biologique 20, 228–236.
- van Roosbroeck S., Hoeck S. & van Hal G. (2012) Population-based screening for colorectal cancer using an immunochemical faecal occult blood test: a comparison of two invitation strategies. Cancer Epidemiology 36, e317–e324.
- Roter D.L. (1977) Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Education Monographs 5, 281–315.
- Roter D. & Larson S. (2002) The Roter interaction analysis system (RIAS): utility and flexibility for analysis of medical interactions. Patient Education and Counseling 46, 243–251.
- Sabatino S.A., Lawrence B., Elder R., Mercer S.L., Wilson K.M., DeVinney B., Melillo S., Carvalho M., Taplin S., Bastani R., Rimer B.K., Vernon S.W., Melvin C.L., Taylor V., Fernandez M. & Glanz K. (2012) Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. The American College of Preventive Medicine 43, 97–118.
- Saint-Lary O., Boisnault P., Naiditch M., Szidon P., Duhot D., Bourgueil Y. & Pelletier-Fleury N. (2012) Performance scores in general practice: a comparison between the clinical versus medication-based approach to identify target populations. PLoS ONE 7, e35721.
- Siddiqui M.R., Sajid M.S., Khatri K., Kanri B., Cheek E. & Baig M.K. (2011) The role of physician reminders in faecal occult blood testing for colorectal cancer screening. European Journal of General Practice 17, 221–228.
- Stewart M., Brown J., Weston W., McWhinney I., McWilliam C. & Freeman T. (2003) Patient-Centered Medicine: Transforming the Clinical Method. Radcliffe Medical Press, Abingdon, UK.
- Supper I., Ecochard R., Bois C., Paumier F., Bez N. & Letrilliart L. (2011) How do French GPs consider participating in primary care research: the DRIM study. Family Practice 28, 226–232.
- Thu-Thon É., Charles R., Froger P., Meyrand B., Paré É. & Trombert B. (2013) Impact d'une formation pour les médecins généralistes sur la participation au dépistage du cancer colorectal. Santé Publique 25, 775–783.
- Von Karsa L., Patnick J. & Segnan N. (2012) European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition-Executive summary. Endoscopy 44(Suppl. 3), SE1–SE8.
- Weller D.P. & Campbell C. (2009) Uptake in cancer screening programmes: a priority in cancer control. British Journal of Cancer 101(Suppl. 2), S55–S59.
- Zajac I.T., Whibley A.H., Cole S.R., Byrne D., Guy J., Morcom J. & Young G.P. (2010) Endorsement by the primary care practitioner consistently improves participation in screening for colorectal cancer: a longitudinal analysis. Journal of Medical Screening 17, 19–24.
