Primary healthcare providers’ knowledge, attitudes, and practices regarding cancer screening recommendation and referral in Georgia, 2023

TL;DR

This study examines how primary healthcare providers in Georgia recommend and refer patients for cancer screening, finding that despite positive attitudes, low referral rates suggest a need for better training and infrastructure.

Contribution

The study identifies specific provider and system-level factors associated with cancer screening referral rates in Georgia.

Findings

Most providers recommend cancer screening, but only 35.3% recommend it for ≥6 patients per week.

Family doctors and those in Tbilisi are more likely to recommend screening frequently.

Training, infrastructure, and perceived role in screening are significant predictors of referral rates.

Abstract

Cancer screening uptake in Georgia is only 13%. We aimed to assess cancer screening recommendations and referral practices among primary health care providers (PHC) and factors associated with these practices.

We conducted a cross-sectional survey of 2,958 doctors and nurses in PHC in November 2023, using descriptive, bivariate, and multivariate analyses to assess the association between provider characteristics, system-level factors, and practices in recommending and referring for cancer screening.

Respondents were predominantly female (95%), mean age of 57.5 years, family doctors (56%), with >20 years’ work experience (60%) and rural practice (67%). Almost all (98%) reported actively recommending and referring patients for cancer screening; however, 64.7% did so for only 1–5 patients per week, while 12% reported none. Predictors of higher recommendation and referral rates (≥6 patients per week) included being a family doctor (AOR 1.36; 95% CI: 1.11–1.67; p = 0.003), working in the capital city – Tbilisi (AOR 1.36; 95% CI: 1.14–1.95; p = 0.003), receiving comprehensive cancer screening training (AOR 1.49; 95% CI: 1.04–1.68; p = 0.024), reporting adequate infrastructure (AOR 1.39; 95% CI: 1.07–1.81; p = 0.015), reporting proper public promotion (AOR 1.41; 95% CI: 1.12–1.78; p = 0.003), and perceiving screening as part of their role (AOR 1.87; 95% CI: 1.52–2.30; p < 0.001).

Despite strong belief in cancer screening, recommendation and referral rates remain low, underscoring the urgent need for policy reforms to enhance education, raise awareness, and improve infrastructure for effective cancer screening initiatives.