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      Willingness of healthcare providers to perform population-based cancer screening: a cross-sectional study in primary healthcare institutions in Tianjin, China

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          Abstract

          Objective

          To evaluate the willingness of healthcare providers to perform population-based screening in primary healthcare institutions in China.

          Methods

          Healthcare providers of 262 primary healthcare institutions in Tianjin were invited to fill out a questionnaire consisting of demographic characteristics, workload, and knowledge of, attitude towards and willingness to perform breast, cervical and colorectal cancer screening. Willingness to screen was the primary outcome. Multilevel logistic regression models were conducted to analyse the determinants of healthcare providers’ willingness to screen. ORs and 95% CIs were estimated.

          Results

          A total of 554 healthcare providers from 244 institutions answered the questionnaire. 67.2%, 72.1% and 74.3% were willing to perform breast, cervical and colorectal cancer screening, respectively. A negative attitude towards screening was associated with a low willingness for cervical (OR=0.27; 95% CI 0.08, 0.94) and colorectal (OR=0.08; 95% CI 0.02, 0.30) cancer screening, while this was not statistically significant for breast cancer screening (OR=0.30; 95% CI 0.08, 1.12). For breast, cervical and colorectal cancer screening, 70.1%, 63.8% and 59.0% of healthcare providers reported a shortage of staff dedicated to screening. A perceived reasonable manpower allocation was a determinant of increased willingness to perform breast (OR=2.86; 95% CI 1.03, 7.88) and colorectal (OR=2.70; 95% CI 1.22, 5.99) cancer screening. However, this was not significant for cervical cancer screening (OR=1.76; 95% CI 0.74, 4.18).

          Conclusions

          In China, healthcare providers with a positive attitude towards screening have a stronger willingness to contribute to cancer screening, and therefore healthcare providers’ attitude, recognition of the importance of screening and acceptable workload should be optimised to improve the uptake of cancer screening.

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          Most cited references39

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          Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020

          Wei Cao, Hong-Da Chen, Yi-Wen Yu … (2021)
          Background: Cancer is one of the leading causes of death globally, but its burden is not uniform. GLOBOCAN 2020 has newly updated the estimates of cancer burden. This study summarizes the most recent changing profiles of cancer burden worldwide and in China and compares the cancer data of China with those of other regions. Methods: We conducted a descriptive secondary analysis of the GLOBOCAN 2020 data. To depict the changing global profile of the leading cancer types in 2020 compared with 2018, we extracted the numbers of cases and deaths in 2018 from GLOBOCAN 2018. We also obtained cancer incidence and mortality from the 2015 National Cancer Registry Report in China when sorting the leading cancer types by new cases and deaths. For the leading cancer types according to sex in China, we summarized the estimated numbers of incidence and mortality, and calculated China's percentage of the global new cases and deaths. Results: Breast cancer displaced lung cancer to become the most leading diagnosed cancer worldwide in 2020. Lung, liver, stomach, breast, and colon cancers were the top five leading causes of cancer-related death, among which liver cancer changed from the third-highest cancer mortality in 2018 to the second-highest in 2020. China accounted for 24% of newly diagnosed cases and 30% of the cancer-related deaths worldwide in 2020. Among the 185 countries included in the database, China's age-standardized incidence rate (204.8 per 100,000) ranked 65th and the age-standardized mortality rate (129.4 per 100,000) ranked 13th. The two rates were above the global average. Lung cancer remained the most common cancer type and the leading cause of cancer death in China. However, breast cancer became the most frequent cancer type among women if the incidence was stratified by sex. Incidences of colorectal cancer and breast cancer increased rapidly. The leading causes of cancer death varied minimally in ranking from 2015 to 2020 in China. Gastrointestinal cancers, including stomach, colorectal, liver, and esophageal cancers, contributed to a massive burden of cancer for both sexes. Conclusions: The burden of breast cancer is increasing globally. China is undergoing cancer transition with an increasing burden of lung cancer, gastrointestinal cancer, and breast cancers. The mortality rate of cancer in China is high. Comprehensive strategies are urgently needed to target China's changing profiles of the cancer burden.
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            Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.

            Kevin C Oeffinger, Elizabeth Fontham, Ruth Etzioni … (2015)
            Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality.
            Article 0 comments Cited 479 times – based on 0 reviews     Review now
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              The primary health-care system in China

              Xi Li, Jiapeng Lu, Shuang Hu … (2017)
              China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidies and incentives that do not encourage cost savings and good performance, insurance policies that hamper the efficiency of care delivery, an insufficient quality measurement and improvement system, and poor performance in the control of risk factors (such as hypertension and diabetes). As China deepens its health-care reform, it has the opportunity to build an integrated, cooperative primary health-care system, generating knowledge from practice that can support improvements, and bolstered by evidence-based performance indicators and incentives.
              Article 0 comments Cited 298 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2024
                Publication date (Electronic): 2 April 2024
                Volume: 14
                Issue: 4
                Electronic Location Identifier: e075604
                Affiliations
                [1 ] departmentDepartment of Epidemiology , Ringgold_84792University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
                [2 ] departmentDepartment of Epidemiology and Health Statistics , Ringgold_12610Tianjin Medical University , Tianjin, China
                [3 ] departmentDepartment of Epidemiology and Health Statistics , Ringgold_12517Capital Medical University , Beijing, China
                [4 ] departmentDepartment of Radiology , Ringgold_84792University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
                Author notes
                [Correspondence to ] Dr Wenli Lu; luwenli@ 123456tmu.edu.cn
                Author information
                http://orcid.org/0000-0002-3281-1153
                http://orcid.org/0000-0003-2894-7506
                Article
                Publisher ID: bmjopen-2023-075604
                DOI: 10.1136/bmjopen-2023-075604
                PMC ID: 10989173
                PubMed ID: 38569674
                SO-VID: 133ab7b7-4628-4f5a-abc2-36e6ed8afd8d
                Copyright © © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 15 May 2023
                Date accepted : 17 March 2024
                Funding
                Funded by: National Natural Science Foundation;
                Award ID: 72074166
                Categories
                Subject: Public Health
                Subject: 1506
                Subject: 1724
                Series title: Original research
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: breast tumours,gastrointestinal tumours,gynaecological oncology,mass screening,health policy,primary health care
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: breast tumours, gastrointestinal tumours, gynaecological oncology, mass screening, health policy, primary health care

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