Martin J A, Crotty B, Barbaro D, Higlett T, Zalcberg J
Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
ANZ J Surg. 2001 Dec;71(12):715-9. doi: 10.1046/j.1445-1433.2001.02273.x.
A screening programme to detect polyps or early carcinoma would significantly reduce the mortality and morbidity of colorectal cancer (CRC). The aims of the present study were to evaluate: (i) the feasibility of training general practitioners in flexible sigmoidoscopy (FS) for CRC screening; (ii) the acceptability of screening by faecal occult blood testing (FOBT) and FS in asymptomatic standard risk Australians aged over 50 years; and (iii) the yield of such screening.
Subjects were recruited by general practitioner (GP) referral, newspaper advertisement or by a direct approach to retirement villages. Participants were mailed a FOBT kit and a prescreening questionnaire. Flexible sigmoidoscopy was performed by a GP supervised by an experienced endoscopist. Subjects then completed a second questionnaire. General practitioners were assessed after 50 unassisted procedures.
A total of 264 individuals contacted the study coordinator; 169 were screened. Screening was accepted well by the participants. Fifteen per cent of subjects had polyps and 4% had a positive FOBT. Training in FS was adversely affected by the availability of resources. Three GPs completed 50 unassisted procedures over a 15-month period, but none were able to reliably assess the distal bowel.
Although the three trainees and their supervisors did not consider that the GPs were adequately trained after 50 unassisted procedures, training was adversely affected by limited resources within the Victorian public hospital system. Screening by FOBT and FS was considered to be acceptable by the patients undergoing these procedures. Existing facilities are not adequate if GPs are to be trained in FS as part of a national CRC screening program.
一项用于检测息肉或早期癌的筛查计划将显著降低结直肠癌（CRC）的死亡率和发病率。本研究的目的是评估：（i）培训全科医生进行结肠镜检查（FS）以用于CRC筛查的可行性；（ii）50岁以上无症状标准风险澳大利亚人对粪便潜血试验（FOBT）和FS筛查的接受程度；（iii）这种筛查的检出率。
通过全科医生（GP）转诊、报纸广告或直接联系退休村招募受试者。向参与者邮寄一份FOBT试剂盒和一份预筛查问卷。结肠镜检查由一名在经验丰富的内镜医师监督下的全科医生进行。受试者随后完成第二份问卷。在50次独立操作后对全科医生进行评估。
共有264人联系了研究协调员；169人接受了筛查。参与者对筛查接受度良好。15%的受试者有息肉，4%的受试者FOBT呈阳性。FS培训受到资源可用性的不利影响。三名全科医生在15个月内完成了50次独立操作，但没有人能够可靠地评估远端肠道。
尽管三名受训者及其监督者认为全科医生在50次独立操作后没有得到充分培训，但培训受到维多利亚州公立医院系统内资源有限的不利影响。接受FOBT和FS筛查的患者认为这种筛查是可以接受的。如果要将全科医生培训为FS作为国家CRC筛查计划的一部分，现有设施是不够的。
