TRAINING PRIMARY CARE PHYSICIANS IN SHARED DECISION MAKING FOR COLORECTAL CANCER SCREENING. INSIGHTS FROM A STATEWIDE COLORECTAL CANCER SCREENING PROGRAM IN SWITZERLAND

Purpose: Colorectal cancer (CRC) screening can reduce CRC mortality. The canton of Vaud is about to launch the first statewide, systematic screening program in Switzerland, offering eligible citizens either fecal-immunological testing for occult blood (FIT) or colonoscopy on an equal basis. However, there are currently wide variations among primary care physicians (PCPs) on the type of screening modality offered. Shared decision making (SDM) has been promoted as a model for reducing variations in care. We aimed to assess the impact of a training program on PCPs’ intent to offer patients FIT and colonoscopy on an equal basis.

Methods: Survey given before and after training seminars to participating PCPs. Parallel comparison through a mailed survey to PCPs not attending the training seminars. The training consisted of 2 hour-long seminar including interactive quizzes, an 8-minute video of a SDM consultation, and distribution of tools such as a decision aid, diagram for during consultations, and evidence synopsis. The primary outcome was the intention of having their patients screened with FIT and colonoscopy in equal proportions (i.e. between 40 and 60% each). Secondary outcomes were the perceived role of physicians in the decision (active/collaborative (SDM)/passive) and appropriate use of screening in a clinical vignette.

Results: Out of 620 eligible PCPs, 133(21%) attended one of 6 seminar sessions held throughout the state of which 96 filled the surveys. 109(16%) PCPs who did not attend the seminars returned the survey. Before the seminars, 9% of physicians reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 36% foresaw having their patients screened in equal proportions (absolute difference 27%, adjusted relative risk 4.2,95%CI:2.1 to 8.7,p<0.001). Among those not attending, there was no change in intentions to have their patients screened in equal proportions (13% vs 14%). The proportion reporting SDM as their communication style did not significantly change before and after the training (47% vs 51%,p=0.6) and compared to those not attending (44%,p=0.3). Of those attending, the proportion adequately offering CRC screening in a clinical vignette increased from 88% to 99%(p=0.04;86% in those not attending).

Conclusion: An interactive training seminar increased the proportion of physicians with the intention to prescribe FIT and colonoscopy in equal proportions.