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Abstract
Background Guidelines recommend primary care physicians (PCPs) offer patients a choice between colonoscopy and faecal immunochemical test (FIT) for colorectal cancer (CRC) screening. Patients choose almost evenly between both tests but in Switzerland, most are tested with colonoscopy while screening rates are low. A quality circle (QC) of PCPs is an ideal site to train physicians in shared decision-making (SDM) that will help more patients decide if they want to be tested and choose the test they prefer.
Objective Systematically assess CRC screening status of eligible 50–75 y.o. patients and through SDM increase the proportion of patients who have the opportunity to choose CRC screening and the test (FIT or colonoscopy).
Methods Working through four Plan-Do-Study-Act (PDSA) cycles in their QC, PCPs adapted tools for SDM and surmounted organisational barriers by involving practice assistants. Each PCP included 20, then 40 consecutive 50–75 y.o. patients, repeatedly reported CRC status as well as the proportion of eligible patients with whom CRC screening could be discussed and patients’ decisions.
Results 9 PCPs initially included 176, then 320 patients. CRC screening status was routinely noted in the electronic medical record and CRC screening was implemented in daily routine, increasing eligible patients’ chance to be offered screening. Over a year, screening rates trended upwards, from 37% to 40% (p=0.46) and FIT use increased (2%–7%, p=0.008). Initially, 7/9 PCPs had no patient ever tested with FIT; after the intervention, only 2/8 recorded no FIT tests.
Conclusions Through data-driven PDSA cycles and significant organisational changes, PCPs of a QC systematically collected data on CRC screening status and implemented SDM tools in their daily routine. This increased patients’ chance to discuss CRC screening. The more balanced use of FIT and colonoscopy suggests that patients’ values and preferences were better respected.
- primary care
- shared decision making
- quality improvement
- patient-centred care
- PDSA
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Footnotes
Contributors YM helped conducting the study and wrote the manuscript, LAB helped conducting the study and revised the manuscript, MA-J helped conducting the study and revised the manuscript, KT helped concepting the manuscript and edited it, NB-A gave her ethical expertise and revised the manuscript, CD gave his expertise on CRC screening and revised the manuscript, KS gave his expertise on CRC screening and revised the manuscript, RA designed and helped conducting the study, and revised the manuscript, AR helped conducting the study, supervised the writing and can be designed as guarantor.
Funding This work was supported by the funds from the Swiss National Scientific Foundations National Research Plan 74 NFP74. 407440_167519. The funders had no role in the design or conduct of the study, in the collection, management, analysis or interpretation of data, nor in the preparation, review or approval of the manuscript.
Competing interests CD is medical director of the organised CRC screening program of Canton of Vaud in Switzerland. This program is implemented in close collaboration with primary care physicians and offers colonoscopy and FIT to all citizens aged 50 to 69 years. KS reports grants from Swiss Cancer Foundation, outside the submitted work. He is part of the steering committee for the CRC screening program for the Canton of Vaud mentioned above. He is also a primary care physician. RA reports grants from Swiss National Science Fundation, during the conduct of the study, and works part-time as a primary care physician where he actively offers choice of CRC testing options to patients. He is active in the implementation of the CRC screening program of Canton of Vaud in Switzerland mentioned above. AR is a primary care physician and facilitator of the quality circle at the healthcare centre where the study took place. Member of the board for quality improvement of Medbase, a network of health care centres providing primary healthcare in Switzerland.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.