Familial colonoscopic screening: how do French general practitioners deal with patients and their high-risk relatives. A qualitative study

Figures & data

Table 1. CRC levels of risk and corresponding screening strategies.

	Average risk	Increased risk	Very high risk
Targeted population	General population 50–74 years old Symptom-free	Personal history of chronic inflammatory bowel disease Crohn’s disease Ulcerative colitis History of adenoma or CRC Personal Familial: CRC or adenoma occurring in a first-degree relative before the age of 65, or two or more instances of family history occurring in FDRs, irrespective of age of diagnosis	Inherited predisposition Familial adenomatous polyposis (FAP) Hereditary non-polyposis colorectal cancer (Lynch syndrome)
Screening strategy	Organised screening Faecal occult blood test (every 2 years)	Family individual screening Gastroenterology consultation and follow-up Colonoscopy/chromoendoscopy^a from age 45, or 10 years before the age of diagnosis of the index patient, whichever comes first	Individual screening Oncogenetics consultation (search for specific mutation) Gastroenterology consultation Chromoendoscopy^a

Reproduced from HAS 2017 [5].

^aChromoendoscopy is an examination complementary to colonoscopy that consists in marking certain areas of the digestive tract with different dyes, using a spray catheter passed through the operating channel of the endoscope.

Table 2. Characteristics of general practitioners.

Anonymity^a	Gender	Age	Urban/periurban/rural area (region)
GP1	Female	[60–75]	Periurban (Nouvelle-Aquitaine)
GP6	Male	[30–40]	Urban (Nouvelle-Aquitaine)
GP6-2	Female	[40–50]	Periurban (Nouvelle-Aquitaine)
GP7-1	Female	[40–50]	Periurban (Nouvelle-Aquitaine)
GP8	Male	[50–60]	Rural (Nouvelle-Aquitaine)
GP8-2	Female	[30–40]	Rural (Nouvelle-Aquitaine)
GP10	Male	[40–50]	Rural (Nouvelle-Aquitaine)
GP14	Male	[50–60]	Urban (Nouvelle-Aquitaine)
GP15-1	Female	[40–50]	Periurban (Nouvelle-Aquitaine)
GP15-3	Female	[40–50]	Periurban (Pays de la Loire)
GP16	Male	[60–75]	Urban (Nouvelle-Aquitaine)
GP18-2	Male	[50–60]	Periurban (Nouvelle-Aquitaine)
GP18-3	Male	[50–60]	Periurban (Nouvelle-Aquitaine)
GP19	Female	[40–50]	Periurban (Nouvelle-Aquitaine)
GP20-1	Male	[40–50]	Rural (Occitanie)
GP20-2	Female	[40–50]	Urban (Nouvelle-Aquitaine)
GP23	Female	[50–60]	Rural (Nouvelle-Aquitaine)
GP25	Male	[30–40]	Periurban (Nouvelle-Aquitaine)
GP27	Male	[50–60]	Periurban (Nouvelle-Aquitaine)
GP29-1	Male	[50–60]	Periurban (Nouvelle-Aquitaine)
GP30	Male	[50–60]	Rural (Nouvelle-Aquitaine)
GP-30F	Female	[30–40]	Periurban (Nouvelle-Aquitaine)
GP32-3	Female	[40–50]	Rural (Nouvelle-Aquitaine)
GP44-3	Male	[50–60]	Urban (Occitanie)
GP46	Female	[50–60]	Periurban (Nouvelle-Aquitaine)
GP49	Female	[50–60]	Urban (Nouvelle-Aquitaine)
GP51	Female	[50–60]	Periurban (Nouvelle-Aquitaine)
GP55	Female	[60–75]	Urban (Nouvelle-Aquitaine)
GP56-3	Male	[40–50]	Periurban (Nouvelle-Aquitaine)
GP58	Male	[50–60]	Periurban (Nouvelle-Aquitaine)
GP59	Male	[60–75]	Urban (Nouvelle-Aquitaine)
GP60	Male	[50–60]	Rural (Nouvelle-Aquitaine)
GP61	Female	[30–40]	Urban (Nouvelle-Aquitaine)
GP67	Female	[30–40]	Rural (Nouvelle-Aquitaine)
GP71	Male	[60–75]	Urban (Nouvelle-Aquitaine)

^aThe GP identification corresponds to the number of the patient included in the COLOR3 study.

An index patient’s doctor is identified by this number alone (GP29). A sibling’s doctor is identified by the index patient’s number followed by the sibling's rank (GP29-1, GP29-2…). The physician of the parent of an index patient is identified by the index patient’s number followed by F (father) or M (mother).

Table 3. Opening questions and inquiry rationale for semi-structured interviews.

Themes	Questions
Nature of interactions with the index patient or FDR Chronology of discussions about the discovery of the cancer Knowledge of family history	What was the nature of your discussion with your patient – first name, last name – about his/her colorectal cancer?
Discussion of family risk with the index case Assessment of the chronology of the exchanges initiated by the GP, by the patient Assessment of the transmission of the recommendation by the GP Assessment of the GP's role in family screening Assessment of the patient's understanding of the recommendation Assessment of the limitations of the family screening	Did you discuss this issue of familial risk with your patient? If you did, what was the nature of the discussion? If not, what difficulties did you encounter?
Discussion of family risk with the FDR Assessment of the chronology of the exchanges initiated by the GP, by the patient Assessment of the transmission of the recommendation by the GP Assessment of the GP's role in family screening Assessment of the patient's understanding of the recommendation Assessment of the limitations of the family screening	Did you discuss this issue of familial risk with your patient? If you did, what was the nature of the discussion? If not, what difficulties did you encounter?
Possible FDRs in the same practice as the index patient	Do you have any index patient's FDRs in your practice? Have you spoken with any of them about high risk?
Questioning on family history Questioning of the GP/spontaneous statement of the patient In which consultation settings do you talk to your patients about their family history of cancer?	In which consultation contexts do you talk to your patients about their family history of cancer?
Knowledge of guidelines for CRC family screening	Around what age do you refer relatives for colonoscopy?
Suggestions for improving the implementation of the recommendations	What tools would you find useful to improve your knowledge of your patient’s family history?

Table 4. Themes and categories developed from GPs’ interview data about familial CRC screening.

Themes	Knowledge of guidelines	Involvement with index patients	Involvement with high-risk relatives	Barriers for GPs to envisage family CRC	Proposals for improving the implementation of the guidelines
Categories	Identifying high-risk relatives Age at diagnosis of index patient Age of the first colonoscopy for FDRs Adenomas included in the guidelines alongside cancers	Recalling the guidelines Relaying the recommendation Supporting the patient during the process Replacing the patient if necessary	Investigating the level of risk Questioning about family history Coordination with organised screening Fear of missing early detection	Lack of time or availability Lack of involvement in prevention Lack of personalised guidelines Incomplete family history	Guidelines included in the reports Improved organised screening and awareness campaigns Updating family history A similar organisation to that of oncogenetic consultations

Registre des cancers Poitou-Charentes. [cited 2022 Jan 13]. Available from: https://www.registre-cancers-poitou-charentes.fr/les-chiffres_723.html.

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