SNFGE SNFGE
 
Thématique :
- Cancer colorectal (CCR)
- Colo-proctologie
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Frank ZERBIB
Coup de coeur :
 
 
Journal of the American Medical Association (JAMA)
  2017/09  
 
  2017 Sep 5;318(9):816-824.  
  doi: 10.1001/jama.2017.11387.  
 
  Effect of Physician Notification Regarding Nonadherence to Colorectal Cancer Screening on Patient Participation in Fecal Immunochemical Test Cancer Screening: A Randomized Clinical Trial.  
 
  Rat C, Pogu C, Le Donné D, Latour C, Bianco G, Nanin F, Cowppli-Bony A, Gaultier A, Nguyen JM  
  https://www.ncbi.nlm.nih.gov/pubmed/28873160  
 
 

Abstract

IMPORTANCE:

Increasing participation in fecal screening tests is a major challenge in countries that have implemented colorectal cancer (CRC) screening programs.

OBJECTIVE:

To determine whether providing general practitioners (GPs) a list of patients who are nonadherent to CRC screening enhances patient participation in fecal immunochemical testing (FIT).

DESIGN, SETTING, AND PARTICIPANTS:

A 3-group, cluster-randomized study was conducted from July 14, 2015, to July 14, 2016, on the west coast of France, with GPs in 801 practices participating and involving adult patients (50-74 years) who were at average risk of CRC and not up-to-date with CRC screening. The final follow-up date was July 14, 2016.

INTERVENTIONS:

General practitioners were randomly assigned to 1 of 3 groups: 496 received a list of patients who had not undergone CRC screening (patient-specific reminders group, 10 476 patients), 495 received a letter describing region-specific CRC screening adherence rates (generic reminders group, 10 606 patients), and 455 did not receive any reminders (usual care group, 10 147 patients).

MAIN OUTCOMES AND MEASURES:

The primary end point was patient participation in CRC screening 1 year after the intervention.

RESULTS:

Among 1482 randomized GPs (mean age, 53.4 years; 576 women [38.9%]), 1446 participated; of the 33 044 patients of these GPs (mean age, 59.7 years; 17 949 women [54.3%]), follow-up at 1 year was available for 31 229 (94.5%). At 1 year, 24.8% (95% CI, 23.4%-26.2%) of patients in the specific reminders group, 21.7% (95% CI, 20.5%-22.8%) in the generic reminders group, and 20.6% (95% CI, 19.3%-21.8%) in the usual care group participated in the FIT screening. The between-group differences were 3.1% (95% CI, 1.3%-5.0%) for the patient-specific reminders group vs the generic reminders group, 4.2% (95% CI, 2.3%-6.2%) for the patient-specific reminders group vs the usual care group, and 1.1% (95% CI, -0.6% to 2.8%) for generic reminders group vs the usual care group.

CONCLUSIONS AND RELEVANCE:

Providing French GPs caring for adults at average risk of CRC with a list of their patients who were not up-to-date with their CRC screening resulted in a small but significant increase in patient participation in FIT screening at 1 year compared with patients who received usual care. Providing GPs with generic reminders about regional rates of CRC screening did not increase screening rates compared with usual care.

 
Question posée
 
Peut-on augmenter la participation à la campagne de dépistage du CCR en sensibilisant les généralistes ?
 
Question posée
 
Fournir aux médecins une liste de patients n’ayant pas répondu à l’invitation augmente de manière faible (3 à 4%) mais significative le taux de participation. Sensibiliser les médecins en donnant des chiffres sur la participation régionale à la campagne n’a pas d’impact significatif.
 
Commentaires

Etude originale, française, dont les résultats sont globalement décevants compte tenu de l’augmentation des taux observés. L’idée d’une personnalisation accrue du message en faveur du dépistage est pourtant séduisante. Mais il probable que convaincre une personne qui n’avait pas spontanément décidé de participer est difficile. Ces démarches sont probablement couteuses également. 

 
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