What influences the decision by primary care doctors to recommend cancer screening? A qualitative evidence synthesis

Objectives This review synthesised evidence from studies about the perceptions and experiences of primary care doctors (PCDs) regarding the factors that influenced or inhibited their decision to recommend cancer screening. Design Qualitative evidence synthesis (QES) following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guideline.

Data sources MEDLINE, Web of Science, Embase and the Cochrane Library for eligible studies that were published between 1 January 2000 and 22 January 2025. Eligibility criteria We included peer-reviewed studies which involved PCDs (in private or public settings in any country), covered cancer screening guideline recommendations and written in English.

Data extraction and synthesis Two independent reviewers conducted article screening, data extraction, quality assessment and coding. The review team discussed, reviewed, and refined the descriptive themes and analytical themes to reach higher-level interpretation.

Results Nine studies were included in this QES. The synthesis of evidence identified three main analytical themes.

First, PCDs demonstrated positive attitudes towards cancer screening guidelines even though there were some concerns regarding false-negative results and colonoscopy-related complications as well as a perceived lack of rewards/compensation for adhering to screening guidelines. Second, implementation challenges were noted including patient factors, PCD-related inhibitors, health system-related barriers and challenges related to cancer awareness and beliefs.

Thirdly, the factors that were perceived by PCDs to facilitate guideline adherence included integration of digital record systems, reminders and raising community awareness about screening. Only one study was conducted in a low-middle-income country, and it indicated that resource limitations, including the unavailability of FOBT tests, were reported to reduce PCDs' motivation to implement cancer screening recommendations.

In addition, cancer-related stigma, cultural beliefs and misconceptions about cancer - such as preferring home or religious remedies - were perceived as barriers to screening uptake, highlighting the need for stronger public health education and awareness initiatives. Conclusion There tends to be good adherence to screening guidelines among PCDs across various countries and healthcare systems at least relating to colorectal cancer and, to a lesser extent, cervical cancer.

Studies about adherence to BC screening in primary care are required. The incorporation of an array of interrelated factors appears to facilitate adherence.

We know less about cancer guideline adherence in resource-constrained settings, and there is a need for studies in primary care in LMICs.