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02 Promoting participatory medicine in colorectal cancer screening

 

In Switzerland, only one in five people in the affected groups are screened for colon cancer. Most are not told they could be tested, or that can choose between tests. If primary care providers are trained in participatory medicine, they can ensure patients can make informed choices that match their values and preferences.

Portrait / project description (ongoing research project)

We will measure screening practices within a network of practices that includes 100 to 150 primary care physicians across Switzerland. Each practice will measure 40 patients a year. At the same time, we will randomly assign 96 family physician offices, located in two cantons, to either the intervention or control group. The intervention group will participate in a training program. All practices will describe the way they screen before the program, and we will track these practices afterwards. We will compare the results of the two groups to evaluate the effectiveness of the training. We will form a user-citizen group to advise the research team on conduct of the project and how to disseminate project results.

Background

If patients are screened for colon cancer, mortality from this cancer is halved. The test that most accurately detects cancers is colonoscopy. However, blood testing stool offers fewer disadvantages. Few are asked if they want to be screened, and even fewer are asked to choose between tests, though basic insurance reimburses both tests in Switzerland. The canton of Vaud addressed this situation by creating a colon cancer screening program that allows every person who lives in the canton to consult with their primary care provider and make an informed choice about screening, and method.

Aim

The primary objective of the study is to measure screening activity in family medicine. Our primary measures are the number of people who are asked if they want to take a test, the type of test they choose, and the number who refuse screening. We will use the measurement method in a training program for primary care providers, so they can improve their practice by discussing the issue with their colleagues. Our goal is to increase the proportion of patients offered screening options, and reduce differences in patient screening across family medicine practices.

Relevance / Application

This study is will promote participatory medicine and place user-citizens at the centre of the system of care. We endorse a paradigm shift from absolute compliance to physician recommendations, to shared decision making. We will develop and test new methods to train primary care physicians in participatory medicine, so that doctors respect the preferences and values of the patients to whom they offer screening. If successful, this method of fostering participatory medicine will be extended and adapted in other areas.

Original title

Shared decision making in colorectal cancer screening in primary care: a cluster randomized controlled trial

Project leaders

Applicant:

  • Prof. Dr. med. Reto Auer MD, MAS, Berner Institut für Hausarztmedizin, Universität Bern

Co-applicants:

  • Jean-Luc Bulliard, Institut Universitaire de Médecine Sociale et Préventive (IUMSP), Centre Hospitalier Universitaire Vaudois (CHUV) et Université de Lausanne
  • Prof. Nikola Biller-Andorno, Institut für Biomedizinische Ethik und Medizingeschichte, Universität Zürich
  • Prof. Jacques Cornuz, Policlinique Médicale Universitaire, Université de Lausanne

Project partners:

  • Dr. Adrian Rohrbasser, Nuffield Department of Primary Care, Health Sciences, University of Oxford
  • Prof. France Légaré, Département de médecine familiale, Faculté de Médecine, Université Laval, Québec

 

 

Further information on this content

 Contact

Prof. Dr. med. Reto Auer Leiter Forschung
Universität Bern
Berner Institut für Hausarztmedizin (BIHAM)
Gesellschaftsstrasse 49 3012 Bern +41 31 631 58 79 reto.auer@biham.unibe.ch

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