Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

Abstract

GP DA testing performs as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction.

The elusive diagnosis of cancer: testing times

“…14 MDCs that retain responsibility for the patient until their symptoms are explained and managed are distinct from GP direct access (cancer) testing which leaves these actions to the GP. 15 After years of investment in cancer sitespecific urgent referral pathways, this change in thinking appeals to generalists and specialists interested in explaining symptom causation and frustrated with subspecialist silos restricted to one cancer site. But for these MDCs to function, their positioning must become established within local healthcare systems, and test access and patient flow must be liberated to allow cross-speciality referrals and shared multidisciplinary clinical responsibility.…”

Patient experiences of the urgent cancer referral pathway—Can the NHS do better? Semi‐structured interviews with patients with upper gastrointestinal cancer

“…This has also been identified in an endoscopy patient experience study 58 and highlights a potential area for improvement, as previous literature has identified that a straight‐to‐test protocol results in a reduction in times to cancer diagnosis and cancer treatment 59,60 . In addition, GP direct access testing performed as well as, and on some measures better than, consultant‐triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction 61 …”

“…59,60 In addition, GP direct access testing performed as well as, and on some measures better than, consultant-triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction. 61 At the referral stage, whilst health-care professionals may not want to create unnecessary anxiety for patients, previous research suggests fear can actually be increased if the patient feels unclear or unprepared for the cancer referral pathway. 62,63 Patients in a previous head and neck cancer study reported that health-care professionals rarely used the word 'cancer'.…”

General practitioner referrals to one-stop clinics for symptoms that could be indicative of cancer: a systematic review of use and clinical outcomes

“…Our search strategy was purposefully kept broad and included terms describing other diagnostic strategies such as direct access and fast track testing. This was done to avoid missing relevant papers because of differences in terminology, and with a view to summarising the literature for the other diagnostic strategies which has been reported elsewhere (8).…”

“…CT scan or MRI, without the need to refer to or consult with a specialist with the aim of speeding up access to testing (43). A recent systematic review reported that like one-stop clinics, direct access clinics were associated with a reduction in time from referral to testing (8). Unlike one-stop clinics, however, there was no significant reduction in time from referral to diagnosis.…”