Knowledge of colorectal cancer risk factors and screening recommendations: A crosssectional study of regional Australian general practice patients

Abstract

Introduction: Higher levels of knowledge relating to colorectal cancer (CRC) are positively associated with CRC screening behaviour.1 However, knowledge of CRC risk factors and screening recommendations is low.1,2 The aim of this study was to examine knowledge of CRC risk factors and CRC screening recommendations among general practice patients aged 18–85 years, and the sociodemographic characteristics associated with knowledge. Methods: This study was conducted in a convenience sample of five regional general practices in New South Wales (NSW), Australia, between December 2015 and March 2017. The practices had six to 18 practitioners and provided private and bulk-billing services. A consecutive sample of patients aged 18–85 years who spoke English and presented for a general practice appointment were invited to participate. Data collection: Consenting patients completed a touchscreen survey in the waiting room. Ethics approval was received from the University of Newcastle Human Research Ethics Committee (H-2014-0198). Measures: A 5-item survey, developed and piloted by the authors, assessed knowledge using a multiple-choice format. Participants were asked to identify which risk factors may increase a person’s chance of developing CRC: smoking, being older than 50, being overweight, not eating enough fibre, and drinking alcohol regularly. Four questions assessed knowledge of CRC screening recommendations for people at average risk of CRC (lay description provided). These included: 1) age to commence screening; 2) type of screening test recommended; 3) how often the faecal occult blood test (FOBT) should be done; and 4) what a positive FOBT result means. Participants could select one response for each of these questions. Correct responses aligned with Royal Australian College of General Practitioners guidelines for preventive activities in general practice.3 Participants reported their age, gender, marital status, employment status and highest level of education. Data analysis: Scores for risk and screening were analysed separately using logistic regression (binary for risk [>1 versus 1] and ordinal for screening) to model the odds of higher scores. All demographics were included in the model. The Brant test assessed the parallel regression assumption, the Pearson’s goodness-of-fit test assessed the binary model, and each model fit adequately. Results: A total of 510 patients (70% of those assessed) were eligible to participate. Of these, 411 patients consented to participate (81% consent rate). Those with missing data were removed, leaving 363 participants in the final analyses. There was no significant difference in gender between consenters and nonconsenters (Χ2(1) 1.29, p = .254). Participant characteristics: More than half the sample was aged 50–74 years (n = 208; 57%), and similar proportions were aged 18–49 (n = 65; 18%), or 75–85 (n = 90; 25%). A total of 219 (60%) participants were female.