Programme no. 336-OP
The effect of Continuing Medical Education (CME) in early cancer diagnosis on general practitioner’s knowledge and attitude.
Berit Skjødeberg Toftegaard*1, Alina Zalounina Falborg2, Peter Vedsted3, Flemming Bro4
1Department of Public Health, Aarhus University,Research Unit for General Practice,Aarhus,Denmark, 2Department of Public Health, Aarhus University,Research Unit for General Practice,Aarhus,Denmark, 3Department of Public Health, Aarhus University,Research Unit for General Practice,Aarhus,Denmark, 4Department of Public Health, Aarhus University,Research Unit for General Practice,Aarhus,Denmark
* = Presenting author
Objectives: To measure the effect of CME in early cancer diagnosis on GP knowledge on cancer symptoms´ PPVs for specific cancer types, and GP attitude towards their own role in cancer diagnostics.
Urgent referral for suspected cancer was introduced in Denmark in 2009. The effect of such an initiative depends on how the general practitioners (GPs) interpret symptoms and refer the right patients timely. Recent research provided insight on symptoms´ positive predictive values (PPV) for specific cancer types and identified cancer diagnostic pitfalls.
The latest Danish cancer plan included a continuing medical education (CME) based on this new knowledge.
202 GPs (27%) completed both the before and after questionnaires. The GPs participating in the CME significantly improved their responses from baseline to follow-up in three out of six knowledge items and in one out of nine attitude items. These changes were statistical significant compared to the changes in the reference GPs.
Examples are that the CME participating GPs increased their proportion of correct responses from 6.2% to 28.4% (p<0.001) when asked “what is the likelihood of a patient aged 40 and above having colorectal cancer the first time the patient presents unintended weight loss and new onset constipation in your practice?”. The increase was significantly higher compared to the change for the reference GPs (p=0.010).
Also, responding to the statement; “The more patients of those I refer to a cancer fast-track pathway are diagnosed with cancer, the better a doctor I am”, the proportion of the CME participating GPs who answered strongly disagree or disagree rose from 59.3% to 79.0% (p<0.001), which was also a statistically significantly larger change compared to the reference GPs (p=0.014).
All GPs in Central Denmark Region were invited to the CME. The CME was a multifaceted three-hour course. 751 GPs were asked to complete an online questionnaire one month before (baseline) and again seven months after the CME (follow-up).
The effect of the CME was assessed by a before-after comparison between three groups: 1) Reference GP (n: 89) who did not participate, 2) Participating GP (n: 81) and 3) GP with a participating colleague (n: 32).
Conclusion: A before-after analysis showed that the CME participating GPs significantly changed their knowledge on symptoms´ PPVs for specific cancer. Additionally, they changed attitude towards a rational PPV of cancer among referred patients.
Points for discussion: 1. Is it likely that a change in knowledge as found above is sustainable? 2. Could it have an impact on the GPs referral to cancer investigation?