Sladden M J, Ward J E
Division of Community and Rural Health, University of Tasmania, Hobart.
Med J Aust. 1999 Feb 1;170(3):110-3. doi: 10.5694/j.1326-5377.1999.tb127677.x.
To determine general practitioners' (GPs) current beliefs, knowledge and self-reported practices of screening for colorectal cancer.
Postal survey of national random sample of 1271 GPs in 1996.
GP views on effectiveness of faecal occult blood testing (FOBT) and flexible sigmoidoscopy in reducing premature death from colorectal cancer in "average-risk" patients (asymptomatic with no family history); views on frequency of tests and target group; use of these tests; and independent predictors of views and use.
Response rate was 67%. FOBT and flexible sigmoidoscopy were said to be effective as screening tests by 38% and 61% of GPs, respectively, but 30% and 25% were unsure. Independent predictors of belief in screening effectiveness were State of practice (for FOBT), male sex and awareness of Gut Foundation guidelines (for flexible sigmoidoscopy) and increasing age (for both). Most often chosen screening frequencies were every year for FOBT (29%), and five-yearly for flexible sigmoidoscopy (24%), although 19% and 26%, respectively, were unsure of the appropriate screening interval. Most often cited target group was people aged over 40 years with first-degree relatives with colorectal cancer: 63% of GPs would offer FOBT and 74%, flexible sigmoidoscopy. Fewer than 3% of GPs were likely to adopt an opportunistic approach to screening, yet 15% would be highly likely to recommend FOBT during a dedicated health check-up for a 58-year-old male patient, and 9% for a female patient.
The absence to date of a coherent national policy on colorectal cancer screening is associated with wide variations in views and practice that are inconsistent with the available evidence. If GPs are to be involved in implementing population screening, national policy must be widely and effectively promulgated.
确定全科医生（GPs）目前对结直肠癌筛查的看法、知识及自我报告的做法。
1996年对1271名全科医生进行全国随机抽样的邮寄调查。
全科医生对粪便潜血试验（FOBT）和乙状结肠镜检查在降低“平均风险”患者（无症状且无家族病史）结直肠癌过早死亡方面有效性的看法；对检查频率和目标群体的看法；这些检查的使用情况；以及看法和使用情况的独立预测因素。
回复率为67%。分别有38%和61%的全科医生认为FOBT和乙状结肠镜检查作为筛查测试是有效的，但分别有30%和25%的人不确定。对筛查有效性的信念的独立预测因素包括执业地区（对于FOBT）、男性、对肠道基金会指南的知晓情况（对于乙状结肠镜检查）以及年龄增长（对于两者）。最常选择的筛查频率是FOBT每年一次（29%），乙状结肠镜检查每五年一次（24%），不过分别有19%和26%的人不确定合适的筛查间隔。最常提及的目标群体是年龄超过40岁且有结直肠癌一级亲属的人：63%的全科医生会提供FOBT，74%的全科医生会提供乙状结肠镜检查。不到3%的全科医生可能会采取机会性筛查方法，但15%的全科医生极有可能在为一名58岁男性患者进行专门健康检查时推荐FOBT，为女性患者推荐的比例为9%。
迄今为止，缺乏关于结直肠癌筛查的连贯国家政策，这与观点和做法的广泛差异相关，这些差异与现有证据不一致。如果全科医生要参与实施人群筛查，国家政策必须广泛且有效地颁布。
