Postures communicationnelles des spécialistes en médecine générale dans le dépistage familial du cancer colorectal.

Abstract

Introduction: First-degree relatives (FDRs) of patients with colorectal cancer (CRC) or advanced adenoma before the age of 65 (index patients) are at increased risk of CRC, but the guidelines for family screening of FDRs by colonoscopy are poorly followed. The aim of this study was to describe the involvement of primary care physicians (PCPs) with patients (relatives at high risk of colorectal cancer or index patients) and their communicative stance in the context of family screening in relation to the various people involved (other physicians, index patients, and relatives).

Method: The study was based on 29 semi-structured telephone interviews with French PCPs of index patients and/or their FDRs. The fully transcribed corpus of interviews was put through linguistic analysis using a lexicometric tool to identify discourse objects based on frequency calculations, and for the purposes of thematic sociological analysis.

Results: The analyses showed that family screening is conditioned by communication between PCPs and index patients, whom they encourage to pass on the guidelines to their relatives, and by conversations with doctors from other specialisms, who provide them with precise information about the diagnosis. FDRs have a more "classic" relationship with their PCPs, who ask questions in order to ascertain the patient's history and thus direct them toward appropriate screening. The stance of PCPs thus seems to alternate between supervision and reflection, and between consultation and questioning.