Objective The aim of this study was to assess general practitioner (GP) management practices related to skin cancer prevention and screening during standard medical encounters.
Setting Data on medical encounters addressing skin cancer issues were obtained from a French database containing information from 17 019 standard primary care consultations.
Participants Data were collected between December 2011 and April 2012 by 54 trainees who reported the regular practice of 128 GPs using the International Classification of Primary Care.
Outcome measures Reasons for encounters and the following care processes were recorded: counselling, clinical examinations and referral to a specialist. Medical encounters addressing skin cancer issues were compared with medical encounters that addressed other health problems using a multivariate analysis.
Results Only 0.7% of medical encounters addressed skin cancer issues. When patients did require management of a skin cancer-related issue, this was more likely initiated by the doctor than the patient (70.7% vs 29.3%; p<0.001). Compared with medical encounters addressing other health problems, encounters that addressed skin cancer problems required more tasks (3.7 vs 2.5; p<0.001) and lasted 1 min and 20 s longer (p=0.003). GPs were less involved in clinical examinations (67.5% vs 97.1%; p<0.001), both complete (7.3% vs 22.3%, p<0.001) and partial examinations (60.2% vs 74.9%), and were less involved in counselling (5.7% vs 16.9%; p<0.001). Patients presenting skin cancer issues were referred to a specialist more often than patients consulting for other health problems (39.0% vs 12.1%; p<0.001). GPs performed a biopsy in 6.7% of all skin cancer-related encounters.
Conclusions This study demonstrates discrepancies between the high prevalence of skin cancer and the low rate of medical encounters addressing these issues in general practice. Our findings should be followed by qualitative interviews to better understand the observed practices in this field.
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Contributors CR conceived the study, was responsible for its supervision and was responsible for drafting the manuscript. SH participated in the database extraction and participated in drafting the manuscript. AG performed the statistical analysis and helped draft the manuscript. CG helped participate in study supervision and helped draft the manuscript. AM was responsible for the GP network and for the data collection. LL was responsible for the design of the ECOGEN study and helped draft the manuscript. BD participated in the supervision and provided administrative and technical support. JMN participated in the design of the study, was responsible for the statistical analysis and helped draft the manuscript.
Funding Pfizer and the French National College of Generalist Teachers (Collège National des Généralistes Enseignants Conseil) provided financial support for the ECOGEN project.
Competing interests None declared.
Ethics approval Institutional Review Board Sud-East IV (No L11-149).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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