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Amélioration de la participation des patients au dépistage organisé du cancer colorectal par l'implication des médecins généralistes

Abstract : Background: Currently in France, participation rate in organised colorectal cancer (CRC) screening remains well below European guidelines, despite general practitioners involvement.Objectives: The overall objective of this thesis was to assess general practitioners practices in organized CRC screening, to understand barriers to screening participation and to assess strategies to improve patient participation to screening.Methods: Our work was based on data from the organised screening programme in the Val-de-Marne district. We conducted a retrospective cohort of 157 979 patients followed by 961 general practitioners, an action research among 21 volunteer general practitioners and a cluster-randomized controlled trial including 144 general practitioners and 20,778 patients.Results: A small part of the variability of the likelihood of participation was due to the heterogeneity among physicians (intraclass correlation coefficient, 5.5%). Screening participation was significantly lower in males (odds ratio [OR], 0.79; 95% CI, 0.78 to 0.91), the youngest age group (50-54 years, OR, 0.61; 95% CI, 0.58 -0.63; 55-59 years, OR, 0.76; 95% CI, 0.73-0.80) and patients living in socioeconomically deprived areas (OR, 0.82; 95% CI, 0.77-0.87).We have identified seven essential requirements for general practitioners when screening for CRC: Be proactive, Be partners in care, Take into consideration the patient's family and friends, Position themselves as the expert, Manage time efficiently, Explain the test procedure and Help carry out the test. We were able to identify techniques used for each requirement.Systematic reminders sent by post to general practitioners with the updated list of eligible patients for screening did not significantly improve patient participation to organised CRC screening after taking clustering into account (multilevel analysis).Conclusions: Targeted actions to improve CRC screening participation should focus on patients younger than 60 years, males, and individuals living in deprived areas. Actions to enhance the influence of general practitioners on patient participation should be directed to the overall population of general practitioners. Patient-centred care and reflective practice should be at the heart of initial and continuing medical education, and guidelines based on practice data should be proposed.
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Julien Le Breton. Amélioration de la participation des patients au dépistage organisé du cancer colorectal par l'implication des médecins généralistes. Santé publique et épidémiologie. Université Paris-Saclay, 2016. Français. ⟨NNT : 2016SACLS140⟩. ⟨tel-01541056⟩

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