Offering patients a choice for colorectal cancer screening: a quality improvement pilot study in a quality circle of primary care physicians

[摘要] Background Guidelines recommend primary carephysicians (PCPs) offer patients a choice betweencolonoscopy and faecal immunochemical test (FIT) forcolorectal cancer (CRC) screening. Patients choose almostevenly between both tests but in Switzerland, mostare tested with colonoscopy while screening rates arelow. A quality circle (QC) of PCPs is an ideal site to trainphysicians in shared decision-making (SDM) that will helpmore patients decide if they want to be tested and choosethe test they prefer.Objective Systematically assess CRC screening status ofeligible 50–75 y.o. patients and through SDM increase theproportion of patients who have the opportunity to chooseCRC 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 andsurmounted organisational barriers by involving practiceassistants. Each PCP included 20, then 40 consecutive50–75 y.o. patients, repeatedly reported CRC status aswell as the proportion of eligible patients with whom CRCscreening could be discussed and patients’ decisions.Results 9 PCPs initially included 176, then 320 patients.CRC screening status was routinely noted in the electronicmedical record and CRC screening was implementedin daily routine, increasing eligible patients’ chanceto be offered screening. Over a year, screening ratestrended upwards, from 37% to 40% (p=0.46) and FIT useincreased (2%–7%, p=0.008). Initially, 7/9 PCPs had nopatient ever tested with FIT; after the intervention, only 2/8recorded no FIT tests.Conclusions Through data-driven PDSA cycles andsignificant organisational changes, PCPs of a QCsystematically collected data on CRC screening statusand implemented SDM tools in their daily routine. Thisincreased patients’ chance to discuss CRC screening. Themore balanced use of FIT and colonoscopy suggests thatpatients’ values and preferences were better respected.

[学科分类] 药学