Keywords: General Practitioner, Faecal Immunochemical Test, Colorectal Cancer Screening, Physician Engagement

Background:

Colorectal cancer (CRC) screening aims to detect asymptomatic precancerous and cancerous lesions. A CRC prevention strategy should include active patient education and screening reminders. In Latvia, faecal immunochemical test (FIT) screening can be performed every two years by those aged 50 to 74. The screening system is opportunistic, and patients are not sent invitation letters. While the European Commission recommends that 90% of the eligible population are offered such screening, in 2024, the uptake in Latvia was 26.5%.

Research questions:

What factors influence Latvian General Practitioners' (GPs) engagement with colorectal cancer screening?

Method:

A mixed-methods, cross-sectional study using an anonymous online GP survey, which included multiple-choice, Likert scale and open-ended questions. We sent the survey to EGPRN experts for comment, and then we conducted four pilots, three in-person and one online. Two Latvian GP associations supported us in dissemination. We sent three reminder letters to non-responders.

Results:

A total of 284 GPs participated, 25.9% of all Latvia’s GPs. Most (231, 81.4%) were satisfied with the CRC screening coverage in their own practices. GPs <40 years old were more likely to state that they understood the CRC screening programme than their older colleagues (P=0.04). We found a weak but statistically significant negative correlation between GP age and perceived lack of time to discuss CRC screening with patients (r=−0.037; P=0.037). There was a negative correlation between GPs’ understanding of the screening programme and reporting time constraints for patient discussion (r=−0.164; P=0.006).

Conclusions:

Despite low national CRC screening rates in Latvia, most surveyed GPs expressed satisfaction with their own rates. Younger GPs tended to have a better understanding of the screening programme, but were more likely to report that time constraints stopped them discussing CRC screening with patients. These findings highlight potential areas for targeted GP support and education.

Points for discussion:

1. Why might GPs be satisfied with their CRC screening coverage, when national rates are lower than recommended?

2. How much does GPs’ satisfaction with their screening rates create a barrier to improving those rates?

3. Why might older GPs report having more time to initiate screening conversations?