Investigating participation in the Australian National Bowel Cancer Screening Program through general practice: a survey on practices, challenges and digital opportunities

Nicole Marinucci; Natasha Koloski; Amanda Whaley; Rachael Bagnall; Ayesha Shah; Belinda Goodwin; Gerald Holtmann

doi:10.1071/PU24017

RESEARCH ARTICLE (Open Access)

Investigating participation in the Australian National Bowel Cancer Screening Program through general practice: a survey on practices, challenges and digital opportunities

Nicole Marinucci ^A ^B ^* , Natasha Koloski ^A ^B ^C , Amanda Whaley ^A , Rachael Bagnall ^A , Ayesha Shah ^A ^B , Belinda Goodwin ^D ^E ^F and Gerald Holtmann ^A ^B

+ Author Affiliations

- Author Affiliations

^A Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Qld, Australia.

^B Faculty of Medicine, University of Queensland, Herston, Qld, Australia.

^C Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Qld, Australia.

^D Cancer Council Queensland, Brisbane, Qld, Australia.

^E School of Global and Population Health, University of Melbourne, Vic, Australia.

^F Centre for Health Research, University of Southern Queensland, Springfield, Qld, Australia.

^* Correspondence to: Nicole.marinucci@health.qld.gov.au

Public Health Research and Practice 35, PU24017 https://doi.org/10.1071/PU24017

Submitted: 20 February 2025 Accepted: 5 March 2025 Published: 2 July 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Sax Institute. This is an open access article distributed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC)

Abstract

Objectives

Promoting the Australian National Bowel Cancer Screening Program in general practice has been identified as an effective strategy to increase participation rates. Despite the positive influence general practitioners (GPs) have on patient decision-making, program endorsement is not routinely included within the national program’s policy and practice. The aim of this study was to gain a comprehensive understanding of knowledge, health promotion strategies and the challenges/opportunities for general practice staff to support patient participation and navigation through the National Bowel Cancer Screening Program pathways.

Study type

A 52-item online cross-sectional survey.

Methods

A total of 320 general practice clinics in the Metro South Hospital and Health Service, Queensland, Australia received a direct invitation via email to participate. The survey contained items on knowledge, health promotion strategies and challenges/opportunities to endorse participation in the National Bowel Cancer Screening Program, including enquiry about the utilisation of electronic medical records.

Results

Eighty-eight individuals participated, including GPs, practice managers and practice nurses. Of GPs, 96.2% indicated they were likely to promote the National Bowel Cancer Screening Program to patients. Few participants used systems to identify/notify patients due for screening, and over half indicated that Medicare reimbursements (56.8%) and electronic systems for identifying eligible or overdue patients (53.4%) would support their ability to promote the National Bowel Cancer Screening Program in routine practice.

Conclusion

Early detection and treatment of bowel cancer is a public health priority in Australia and internationally. Findings highlight the willingness of staff to promote participation; however, the need for incentivisation and streamlined software integration to identify and prompt eligible patients to screen through the National Bowel Cancer Screening Program remains. These findings contribute new evidence regarding the resources, preferences and system-level requirements needed to support routine GP endorsement of the National Bowel Cancer Screening Program.

Keywords: bowel cancer, cancer prevention, cancer screening, colorectal cancer, early detection of cancer, general practitioners, primary healthcare, prevention.

References

1 Australian Government. Cancer Data in Australia: Cancer Ranking Data Visualisation. Canberra (AU). 2021. Available at https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-rankings-data-visualisation [cited 29 November 2023].

2 Australian Institute of Health and Welfare. Cancer Risk Data Visualisation. Canberra (AU). 2022. Available at https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-risk-data-visualisation [cited 29 November 2023].

3 Department of Health and Aged Care. General Practice Workforce providing Primary Care services in Australia. 2024. Available at https://hwd.health.gov.au/resources/data/gp-primarycare.html [cited 21 May 2025].

4 Libby G, Brewster DH, McClements PL, Carey FA, Black RJ, Birrell J, et al. The impact of population-based faecal occult blood test screening on colorectal cancer mortality: a matched cohort study. Br J Cancer 2012; 107(2): 255-9.
| Crossref | Google Scholar | PubMed |

5 Australian Institute of Health and Welfare. National Bowel Cancer Screening Program: Monitoring Report 2023. Canberra (AU). 2023. Available at https://www.aihw.gov.au/getmedia/d91f8937-09f0-49f6-8b76-2649b7468de8/aihw-can-154.pdf?v=20230605165741&inline=true [updated 2023; cited 29 November 2023].

6 Australian Institute of Health and Welfare. Cancer Screening Programs Quarterly Data. Canberra (AU). 2022. Available at https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/contents/national-bowel-cancer-screening-program/participation [cited 13 September 2022].

7 Goodwin BC, Ireland MJ, March S, Myers L, Crawford-Williams F, Chambers SK, et al. Strategies for increasing participation in mail-out colorectal cancer screening programs: a systematic review and meta-analysis. Syst Rev 2019; 8(1): 257.
| Crossref | Google Scholar | PubMed |

8 Duffy SW, Myles JP, Maroni R, Mohammad A. Rapid review of evaluation of interventions to improve participation in cancer screening services. J Med Screen 2017; 24(3): 127-45.
| Crossref | Google Scholar | PubMed |

9 Goodwin BC, Crawford-Williams F, Ireland MJ, March S. General practitioner endorsement of mail-out colorectal cancer screening: The perspective of nonparticipants. Transl Behav Med 2020; 10(2): 366-74.
| Crossref | Google Scholar | PubMed |

10 Emery JD, Shaw K, Williams B, Mazza D, Fallon-Ferguson J, Varlow M, et al. The role of primary care in early detection and follow-up of cancer. Nat Rev Clin Oncol 2014; 11(1): 38-48.
| Crossref | Google Scholar | PubMed |

11 National Health and Medical Research Council. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney (AU): Australian Government; 2017. Available at https://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer [cited 29 November 2023].

12 Holden CA, Frank O, Li M, Manocha R, Caruso J, Turnbull D, et al. Engagement of General Practice in an Australian Organised Bowel Cancer Screening Program: A Cross-Sectional Survey of Knowledge and Practice. Asian Pac J Cancer Prev 2020; 21(7): 2099-107.
| Crossref | Google Scholar | PubMed |

13 Lee SM, Obamiro K, Cooper A, Barnett T. General practitioner perspectives on barriers and enablers to bowel cancer screening in rural Tasmania A thematic analysis of face-to face interviews. Aust J Gen Pract 2021; 50(3): 158-63.
| Crossref | Google Scholar | PubMed |

14 Kerryann LL-J, Clare LOR, Charissa SF, Melanie AW, Sarah D, Kate HB. Increasing bowel cancer screening participation: integrating population-wide, primary care and more targeted approaches. Public Health Res Pract 2019; 29(2): 2921916.
| Crossref | Google Scholar |

15 Gertig D, Lee J. Supporting health care providers in cancer screening: the role of the National Cancer Screening Register. Med J Aust 2023; 219(3): 94-8.
| Crossref | Google Scholar | PubMed |

16 McIntosh JG, Emery J, Wood A, Chondros P, Campbell T, Wenkart E, Dixon I, Toner J, Gutierrez J, Govan L, Buckle G, et al. SMARTscreen: Using a novel SMS with narrative communication to increase uptake of the National Bowel Cancer Screening Program. Asia Pac J Clin Oncol 2022; 18: 59.
| Google Scholar |

17 Hirst Y, Skrobanski H, Kerrison RS, Kobayashi LC, Counsell N, Djedovic N, et al. Text-message Reminders in Colorectal Cancer Screening (TRICCS): a randomised controlled trial. Br J Cancer 2017; 116(11): 1408-14.
| Crossref | Google Scholar | PubMed |

18 Lotto LS. Qualitative Data Analysis: A Sourcebook of New Methods: Matthew B. Miles and A. Michael Huberman. Educ Eval Policy An 1986; 8(3): 329-31.
| Crossref | Google Scholar |

19 Berkhout C, Zgorska-Meynard-Moussa S, Willefert-Bouche A, Favre J, Peremans L, Van Royen P. Audiovisual aids in primary healthcare settings’ waiting rooms. A systematic review. Eur J Gen Pract 2018; 24(1): 202-10.
| Crossref | Google Scholar | PubMed |

20 Verbunt E, Boyd L, Creagh N, Milley K, Emery J, Nightingale C, et al. Health care system factors influencing primary healthcare workers’ engagement in national cancer screening programs: a qualitative study. Aust N Z J Public Health 2022; 46(6): 858-64.
| Crossref | Google Scholar | PubMed |

21 Care DoHaA. National Cervical Screening Program - Healthcare provider toolkit. Canberra (AU). 2022. Available at https://www.health.gov.au/our-work/NCSP-healthcare-provider-toolkit [cited 23 November 2023].

22 Australian Institute of Health and Welfare. Cervical Screening in Australia 2019. Canberra (AU): Australian Institute of Health and Welfare; 2019.

23 Department of Health. Practice Incentives Program Quality Improvement Incentive Frequently Asked Questions. Canberra (AU). 2022. Available at https://www.health.gov.au/sites/default/files/2022-12/practice-incentives-program-quality-improvement-incentive-frequently-asked-questions_0.pdf [cited 23 November 2023].

24 Royal Australian College of General Practitioners. Guidelines for Preventive Activities in General Practice. 2021. Available at https://www.health.gov.au/sites/default/files/2022-12/practice-incentives-program-quality-improvement-incentive-frequently-asked-questions_0.pdf [cited 23 November 2023].

25 Holden CA, Frank O, Caruso J, Turnbull D, Reed RL, Miller CL, et al. From participation to diagnostic assessment: a systematic scoping review of the role of the primary healthcare sector in the National Bowel Cancer Screening Program. Aust J Prim Health 2020; 26(3): 191-206.
| Crossref | Google Scholar | PubMed |

26 Wood A, Emery JD, Jenkins M, Chondros P, Campbell T, Wenkart E, et al. The SMARTscreen Trial: a randomised controlled trial investigating the efficacy of a GP-endorsed narrative SMS to increase participation in the Australian National Bowel Cancer Screening Program. Trials 2022; 23(1): 31.
| Crossref | Google Scholar | PubMed |

27 Department of Health and Aged Care. GP Supply and Demand Study. 2024. Available at https://hwd.health.gov.au/supply-and-demand/gp-supply-demand-study.html [cited 21 May 2025].