Perceptions and Practices of General Practitioners towards Oral Cancer and Emerging Risk Factors among Indian Immigrants in Australia: A Qualitative Study
Abstract
:1. Introduction
- What are the oral cancer-related knowledge, beliefs and clinical practices of GPs in Australia?
- What are the perceived barriers for GPs regarding oral cancer risk assessment and counselling of patients?
- What are GPs’ recommendations to promote oral cancer awareness particularly among high-risk populations such as Indians in Australia?
2. Materials and Methods
2.1. Design
2.2. Sampling and Recruitment
2.3. Data Collection
2.4. Data Analysis
2.5. Ethical Considerations
2.6. Rigor
3. Definition of Terms
4. Results
4.1. Oral Cancer-Related Knowledge
4.1.1. Recognition of Symptoms and Risk Factors
I don’t think betel nut on its own is sufficient [to cause oral cancer]. You need all the other things in there that contributes to that…(GP-8)
I haven’t heard of betel quid, specifically. I do know—as I said I know about smokeless tobacco… which, yeah, is a big risk factor…(GP-5)
Because I am from an Indian background…. In India, it was more common because I guess people used to chew paan and gutka. So basically, that was like a betel nut product to be more precise which were the major risk factors of oral cancer…(GP-2)
Middle East is also high risk. Indians, I think Indian background is high risk. Chinese because of the smoking probably, they’re also high risk.(GP-6)
4.1.2. Availability of Risk Products
I know the paans [betel quid] are available in a lot of the restaurants and these products are available in Indian grocery stores.(GP-14)
I know that they’re [areca nut/betel quid] available in certain very limited areas where the ethnic population is predominately Indian...(GP-1)
I think it’s legal. I don’t think that’s a—I don’t think it’s illegal in Australia.(GP-8)
4.1.3. Oral Cancer Training
In Australia no…In India yes. I used to do my internship in a government hospital and we did have a campaign for the doctors [about] how to identify and what to look for.(GP-2)
I mean if someone has it [resource], there’s things we download, but I mean they’re not available unless I actually search for it...(GP-9)
4.2. Oral Cancer-Related Beliefs
4.2.1. Views towards Oral Cancer Scenario in Australia
So, I guess cancer of the oral cavity in general in Australia is pretty low in terms of prevalence and incidents…even among the lower socioeconomic groups who are generally higher risk of smoking, and poorer oral hygiene, the numbers are still very small…I don’t think [it is] an emerging problem.(GP-8)
Well, there might be [increased oral cancer risk] because Australia is having a lot of immigrants. With that, they bring likely new type of diets, and habits, and stuff. So, maybe it might increase the overall cancer risk.(GP-14)
But the way the migration is there, say 10, 15 years down the track, with the number increasing, it’s going to be more easy visibility of these paans and chewing tobacco which is sort of still available. Yes, I predict that [increased oral cancer risk] they will be.(GP-13)
4.2.2. Perceived Role in Oral Cancer Prevention
I cannot stress enough the role of the GP, to be honest, as the GP is always the first point of contact. Because of the universal access to healthcare in Australia through Medicare, most of the patients, more or less, end up with a GP. Even if they know this particular matter is not related to the GP, but they know that the GP can direct them to the right person.(GP-1)
The role of the GP is important because I think you need the biopsy or the referral to a specialist because sometimes the patient will come in and then they will, obviously they don’t think it’s a throat cancer…I think without seeing a GP it’s very hard to diagnose it.(GP-9)
So preventative care is good with GPs in case they find that even if they don’t have ulcers, but they are chewing tobacco, or they can be told about the risk factors and supported to quit.(GP-11)
I think—I find that generally, the Indian population, especially the migrant ones, they don’t—they’re not comfortable in [oral cancer prevention counselling]—they’ll only come when something is really bad. They won’t—in terms of prevention, they’re not very good with coming in for preventative stuff, they’re more—if it gets really bad and the symptoms don’t go away, they might come, they might be in a later stage.(GP-9)
I feel that’s true, a lot of them, they do like to see—they say if you are an Asian you also want to see an Asian doctor, you know what I’m saying… I feel that it’s—they’re more open to that… Because there is cultural ethnicity factor.(GP-4)
4.2.3. Barriers to Oral Cancer Prevention and Management
From the GP’s point of view, I would say a knowledge gap; a lack of being able to do much except for refer. Probably a feeling that—I mean, the mouth is the area of either dentist or specialist in terms of our comfort to biopsy and comfort to manage oral changes and dental changes, and some uncertainty about where to send them I think.(GP-10)
I think when it comes down to barrier, there’s no barrier, it’s just that we focus, as I said earlier as well, we focus more on the smoking part, but we always forget about it—I do try my best to do it, but the barrier is the time. If you’re running short of time and the waiting room is full of patients, so that’s one of the barriers.(GP-13)
The main barrier I have come across is sometimes there is a bit of overlap between dental and oral health issues. We recommend sometimes people do see the dentist and—because the dental assessment is quite often needed to make the better diagnosis. It could be an oral cancer issue. Sometimes people can’t afford seeing a dentist. That is quite a good barrier, I think…(GP-14)
You can call it ignorant behaviour. Yeah, that’s other way but that’s how I see is like they don’t see—they don’t see through actually. So, they’re not familiar with the health system…because most of the Indian patients I have to counsel them, they think why they are charging us the money…(GP-3)
…So, that needs to be incorporated in the undergrad training. In the fellowship training, personally, which I did over here, they’re mostly focused on—they encourage GPs to identify population subgroups and then to know particular problems for them…but I’ve never received CPD activity for cancer. So, it’s kind of lack of effort on both hands.(GP-1)
Because we GPs get annoyed a lot now. Everybody wants you to have a six-month training done in something. So how come we can do six months in breast cancer, six months in cervical cancer, six months in this cancer. So, it’s getting a bit cliché as well, like GPs are in the best position to have it so we usually laugh about it. So, I think if you publish your guidelines like GPs are best suited for that, we’re not even going to look at it…(GP-3)
4.3. Clinical Practices Relating to Oral Cancer
4.3.1. Routine Check-Ups and Examinations
We should be doing it, but we are not. We ask about, do you smoke? It’s a part of our medical profession that we have to. But it’s never been a software tick that you ask about betel use, any betel nut or any other thing.(GP-13)
No, not betel nut. I won’t ask betel nut, but if they are chewing something constantly any addiction, anything else, they usually say on their own, so I wouldn’t really particularly ask for betel nut as such.(GP-11)
We do generally discuss the risk factors …but I don’t generally speak specifically about oral cancer, no.(GP-10)
Oral cancer is not—it’s not something I routinely check for unless someone is a smoker and then I will do the check, I’ll ask them some questions about any sore throat or hoarseness of their voice or any mass lesion or things about that but, if they don’t smoke then I usually don’t do it; don’t screen for it.(GP-9)
4.3.2. Referral Processes
There is no specialist pathway that’s what you do if you think it’s oral cancer. I would probably send him to a centre…(GP-12)
It really depends on what the lesion is…if it’s more on the gums or on the—yeah more on the gums area then I would just refer to a dentist…(GP-4)
4.3.3. Preventative Counselling
It’s also we basically use the guidelines, therapeutic guidelines for oral cancer, but there’s no like true resources, apart from online…I don’t have any access to up to date and other such data. I wish, I’d like to, but I don’t have, no.(GP-13)
Not particularly oral cancer, as there is no screening program available in Australia for oral cancer. Generally, it’s dealt as one of the risks that you get from smoking. So, you just touch base…(GP-1)
I’d be interested to see how that [assessment tool] pans out. I’d be happy to give my comments on how usable it is in general practice.(GP-8)
5. Discussion
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Abbreviations
NS | Nidhi Saraswat |
AG | Ajesh George |
NP | Neeta Prabhu |
RP | Rona Pillay |
BE | Bronwyn Everett |
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Age Range/Group | Gender | Country of Birth | Region/State | Medical Qualifications (Country) | Years of Clinical Practice in Australia |
---|---|---|---|---|---|
25–34 | Female | Pakistan | South Sydney/NSW | Undergraduate (Pakistan) Fellowship (Australia) | 3 |
35–44 | Male | India | North Melbourne/VIC | Undergraduate (Russia) Post-graduate (Russia) | 4 |
35–44 | Male | Pakistan | South Sydney/NSW | Undergraduate (Pakistan) Fellowship (Australia) | 6 |
35–44 | Female | Philippines | South-West Melbourne/VIC | Post-graduate (Philippines) Fellowship (Australia) | 4 |
25–34 | Female | Australia | South Sydney/NSW | Undergraduate (Australia) Post-graduate (Australia) | 3 |
55–64 | Female | India | Western Sydney/NSW | Undergraduate (India) Fellowship (Australia) | 23 |
55–64 | Male | Afghanistan | Western Sydney /NSW | Undergraduate (Afghanistan) Post-graduate (Afghanistan) | 20 |
55–64 | Male | Malaysia | South-West Sydney/NSW | Undergraduate (Australia) | 35 |
35–44 | Male | Australia | South Sydney/NSW | Undergraduate, Fellowship (Australia) | 19 |
25–34 | Male | Australia | South-East Sydney/NSW | Undergraduate, Fellowship (Australia) | 3 |
25–34 | Female | India | Western Sydney/NSW | Undergraduate, Fellowship (Australia) | 3 |
45–54 | Male | India | Sydney-East/NSW | Undergraduate (India) Fellowship (UK) | 6 |
35–44 | Male | Pakistan | North-West Sydney/NSW | Undergraduate (Pakistan) Fellowship (Australia) | 16 |
35–44 | Male | India | North-West Sydney/NSW | Undergraduate (India) Fellowship (UK) | 5 |
Categories | Subcategories |
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Oral cancer-related knowledge |
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Oral cancer-related beliefs |
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Clinical practices relating to oral cancer |
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Saraswat, N.; Pillay, R.; Prabhu, N.; Everett, B.; George, A. Perceptions and Practices of General Practitioners towards Oral Cancer and Emerging Risk Factors among Indian Immigrants in Australia: A Qualitative Study. Int. J. Environ. Res. Public Health 2021, 18, 11111. https://doi.org/10.3390/ijerph182111111
Saraswat N, Pillay R, Prabhu N, Everett B, George A. Perceptions and Practices of General Practitioners towards Oral Cancer and Emerging Risk Factors among Indian Immigrants in Australia: A Qualitative Study. International Journal of Environmental Research and Public Health. 2021; 18(21):11111. https://doi.org/10.3390/ijerph182111111
Chicago/Turabian StyleSaraswat, Nidhi, Rona Pillay, Neeta Prabhu, Bronwyn Everett, and Ajesh George. 2021. "Perceptions and Practices of General Practitioners towards Oral Cancer and Emerging Risk Factors among Indian Immigrants in Australia: A Qualitative Study" International Journal of Environmental Research and Public Health 18, no. 21: 11111. https://doi.org/10.3390/ijerph182111111