An evaluation of the Waitemata District Health Board Bowel Screening Pilot is being undertaken to help inform a decision on whether it is feasible to roll out a national bowel screening programme.
This report follows up the baseline provider survey published in 2012. It tracks changes in the awareness, knowledge, attitudes and perceptions of providers including general practitioners, practice nurses, endoscopy staff and radiology staff in the Waitemata DHB area.
The ongoing surveys of health providers assess awareness and knowledge of the pilot and its delivery mechanisms, as well as perceived impact on normal bowel cancer services at the DHB. It also aims to measure attitudes towards a possible national bowel screening programme.
Purpose
The Ministry of Health (MoH) has funded Waitematā District Health Board (WDHB) to run a Bowel Screening Pilot (BSP) over four years from 2012 – 2016. An evaluation of the BSP is being undertaken by Litmus and Sapere Research Group, the results of which will contribute to a decision on whether or not to roll out a national bowel screening programme. The goal of the evaluation is to determine whether organised bowel screening could be introduced in New Zealand in a way that is effective, safe and acceptable for participants, equitable and economically efficient.
Online surveys of health providers are one of the planned evaluation activities. The purpose of the provider surveys is to assess providers’ awareness and knowledge of the BSP, attitudes towards the BSP and its delivery mechanisms, and perceived impact of the BSP on normal services. The surveys also aim to measure attitudes towards a possible national roll-out of a bowel screening programme. This report presents findings from the first follow-up provider survey, undertaken with general practitioners (GPs), practice nurses, endoscopy staff and radiology staff in WDHB. A baseline provider survey was undertaken in November 2011 – January 2012, prior to the full implementation of the BSP in January 2012, and a second follow-up survey will be undertaken in 2015. The follow-up surveys will enable changes in providers’ awareness, knowledge, attitudes and perceptions to be tracked over time.
Methodology
Questionnaire development incorporated advice from a range of experts. Draft questionnaire content was pretested with primary care and endoscopy staff. The questionnaire was structured to enable different providers to answer different questions, relevant to their role.
The follow-up survey was delivered online over a ten-week period, from 14 October to 20 December 2013. Providers were emailed a link to complete the survey. A total of 80 GPs, 72 practice nurses, 26 other general practice staff, 18 endoscopy staff and 24 radiology staff took part in the survey.
Key Results
Findings from the follow-up provider survey provide indicative and useful information about awareness, knowledge and attitudes to the BSP among WDHB health providers. In particular, it also allows comparison to the 2011 baseline provider survey conducted before the BSP was fully implemented. Key findings from the follow-up provider survey are as follows.
- There is high awareness of the BSP across WDHB GPs, practice nurses, endoscopy and radiology staff.
- Since the 2011 baseline provider survey and the commencement of the BSP, there has been a significant increase in the extent providers feel informed about the BSP, although between 8% and 32% of each of these groups still agree that they are not well informed about it, with radiology staff the least informed and GPs the most informed.
- Overall, GPs and practice nurses are aware of the different roles of general practice in the BSP. Positively, there have been significant improvements in the awareness of each of the roles that were identified as less certain in the 2011 baseline provider survey. Of particular note is the strong agreement that it is the role of GPs to inform BSP participants of positive immunochemical faecal occult blood test (iFOBT) results; although 7% continue to disagree this is their role.
- Similarly, endoscopy staff are aware of the different roles of the Waitakere Hospital Endoscopy Unit (WHEU) in the BSP and have made significant increases in the key areas identified for enhanced understanding, namely, notifying patients who receive a positive iFOBT if they have not been notified by general practice, and referring patients for a computed tomography (CT) colonography if a colonoscopy is not suitable for them. Of note however is a decrease in the awareness of the role of providing colonoscopy results to the BSP Coordination Centre.
- Most GPs, practice nurses and endoscopy staff feel increasingly confident explaining the BSP to patients. However, many radiology staff do not. Similarly, most GPs, practice nurses and endoscopy staff believe that they have an important role in the BSP, whereas only half of radiology staff has this view.
- Despite improving amongst some provider groups, awareness of the New Zealand Familial Gastrointestinal Cancer Registry remains relatively low, especially amongst radiology staff.
- All health providers surveyed view New Zealand’s bowel cancer death rate as a significant health concern.
- There is near universal support among health providers for the BSP in WDHB and for a national bowel screening programme. There is also strong support for use of the iFOBT amongst GPs, practice nurses and endoscopy staff. Radiology staff indicate less support for its use.
- Although the majority of general practice staff reported their workload increased due to the BSP, this was significantly lower than the impact that was expected at the time of the 2011 baseline provider survey. In contrast, endoscopy staff confirmed expectations by universally reporting an increase to their workload. Views on service capacity across the screening pathway are mixed with high levels of ‘don’t knows’ by providers not delivering the service.
- Overall, GPs, practice nurses and endoscopy staff rate their performance delivering relevant BSP activities fairly well, although these ratings tend to be lower than the expected performance ratings given in the 2011 baseline provider survey.
- For GPs, the areas where performance was not rated as highly was referring patients with family history of bowel cancer to the New Zealand Familial Gastrointestinal Cancer Registry, and liaising with the BSP Coordination Centre when unable to contact patients with positive iFOBT results.
- The effectiveness of interfaces between the different service providers in the BSP is varied, with GPs in particular acknowledging an improvement compared to before the launch of the BSP. In contrast, endoscopy staff perceive room to improve the interface between WHEU and general practice.