Breast Cancer Screening in Primary Health Care: Barriers and Predictors of Physicians' Adherence to Screening Guidelines
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- Category: Vol. 78, June 2010
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Breast Cancer Screening in Primary Health Care: Barriers and Predictors of Physicians' Adherence to Screening Guidelines, FATEN A. ALRUDAINI and MOHEI EL-DIN A. SELIM
Abstract
Background and Aim: Breast cancer is a significant public health problem in many developed and developing countries. Early detection by screening can lead to better prognosis. Primary healthcare (PHC) physicians have the opportunity to promote breast cancer screening practices. The aim of this study was to compare junior and senior PHC physicians' perception of breast cancer screening guidelines, and to identify the factors that predict their adherence to screening guidelines.
Subjects and Methods: A comparative cross-sectional design was applied in PHC centers in Riyadh area affiliated to all health sectors during the year 2008. The sample included 43 senior and 132 junior doctors. A self-administered anony-mous questionnaire consisting of open and closed questions was used to collect data regarding physicians' perception and practice about breast cancer screening guidelines.
Results: Senior PHC physicians had higher awareness of the guidelines (p<0.001), with almost double rate. They also had higher scores of knowledge (p=0.001), and attitude (p=0.023). However, there was no difference of statistical significance between senior and junior physicians’ practice in ordering mammograms, which was low in both. The main barrier reported was lack of knowledge about the guidelines, which was higher among junior doctors (p<0.001), while seniors reported more time limitations (p=0.033) and different sex barrier (p=0.044). Multivariate analysis revealed the predictors of practice of breast cancer screening by ordering mammogram according to guidelines were younger physician’s age, non-Saudi nationality, higher attitude score towards breast cancer screening, and awareness of the guidelines.
Conclusion and Recommendations: PHC physicians in Riyadh region have low awareness, knowledge, and practice of breast cancer screening guidelines, especially junior ones. The predictors of practice are physician’s younger age, non-Saudi nationality, and awareness and attitude towards guide-lines. The study limitation is the possible over-reporting of practice, especially among junior doctors. It is recommended to intensify continuing medical education programs related to screening, with more emphasis on Saudi physicians and the juniors. For seniors, time management is needed to free time for such important preventive services.