Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross-sectional survey

Harris, Michael; Vedsted, Peter; Esteva, Magdalena; Murchie, Peter; Aubin-Auger, Isabelle; Azuri, Joseph; Brekke, Mette; Buczkowski, Krzysztof; Buono, Nicola; Costiug, Emiliana; Dinant, Geert Jan; Foreva, Gergana; Babić, Svjetlana Gašparović; Hoffman, Robert D.; Jakob, Eva; Koskela, Tuomas; Marzo-Castillejo, Mercè; Neves, Ana Luísa; Petek, Davorina; Šter, Marija Petek; Sawicka-Powierza, Jolanta; Schneider, Antonius; Smyrnakis, Emmanouil; Streit, Sven; Thulesius, Hans; Weltermann, Birgitta; Taylor, Gordon

doi:10.1136/bmjopen-2018-022904

Cited by 23 publications

(37 citation statements)

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“…There is striking similarity in sample composition with the, albeit larger, English NCDA sample (Swann et al, 2017). Notably, PCI, most sensitive to GP's actions, is unlikely to differ statistically (Harris et al, 2018; Murchie et al, 2011; Rose et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Cancer diagnosis in Scottish primary care: Results from the National Cancer Diagnosis Audit

et al. 2020

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Objective To characterize cancer diagnosis in Scottish primary care and draw comparisons with cancer diagnostic activity in England. Method A national audit of cancer diagnosis was conducted in Scottish and English general practices. Participating GPs collected diagnostic pathway data on patients diagnosed in 2014 from medical records. Data were supplemented by linkage to national cancer registries. Analysis explored and compared patient characteristics, diagnostic intervals, and routes to diagnosis. Results 7.7% of all Scottish general practices in 2017 provided data on 2,014 cancer diagnoses. 71.5% of cases presented to GPs and 37.4% were referred using the “Urgent‐Suspected Cancer” route. The median primary care interval was 5 days (IQR 0‐23 days) and median diagnostic interval was 30 days (IQR 13‐68). Both varied by cancer‐site. Diagnostic intervals were longer in the most remote patients and those with more comorbidities. Scottish and English samples corresponded closely in key characteristics. Conclusions Most people diagnosed with cancer in Scotland present to a GP first. Most are referred and diagnosed quickly, with variations by cancer‐site. Intervals were longest for the most remote patients. GPs in Scotland and England appear to perform equally but, in view of growing differences between health systems, future comparative audits may be informative.

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Section: Discussionmentioning

confidence: 99%

Cancer diagnosis in Scottish primary care: Results from the National Cancer Diagnosis Audit

et al. 2020

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“…Previous studies have investigated factors of importance for the GP's propensity to refer patients for cancer diagnostics. The literature suggests that important factors for the GP's choice of action at first consultation include organisational factors, such as funding system and access to investigations, and contextual factors, such as symptomology and relationship with specialist colleagues [5,19,33].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the diagnostic strategy of the GP, including direct referral or wait-and-see, appears to be multifaceted and to depend on the specific healthcare system, as suggested by a recent study [5].…”

Section: Discussionmentioning

confidence: 99%

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Patient’s travel distance to specialised cancer diagnostics and the association with the general practitioner’s diagnostic strategy and satisfaction with the access to diagnostic procedures: an observational study in Denmark

Virgilsen¹,

Hvidberg

Vedsted³

2020

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Background: Research indicate that when general practitioners (GPs) refer their patients for specialist care, the patient often has long distance. This study had a twofold aim: in accordance to the GP’s suspicion of cancer, we investigated the association between: 1) cancer patient’s travel distance to the first specialised diagnostic facility and the GP’s diagnostic strategy and 2) cancer patient’s travel distance to the first specialised diagnostic facility and satisfaction with the waiting time and the availability of diagnostic investigations.Method: This combined questionnaire- and registry-based study included incident cancer patients diagnosed in the last six months of 2016 where the GP had been involved in the diagnostic process of the patients prior to their diagnosis of cancer (n=3,455). The patient’s travel distance to the first specialised diagnostic facility was calculated by ArcGIS Network Analyst. The diagnostic strategy of the GP and the GP’s satisfaction with the waiting times and the available investigations were assessed from GP questionnaires. Results: When the GP did not suspect cancer or serious illness, an insignificant tendency was seen that longer travel distance to the first specialised diagnostic facility increased the likelihood of the GP using ’wait-and-see’ approach and ’medical treatment’ as diagnostic strategies. The GPs of patients with travel distance longer than 49 kilometres to the first specialised diagnostic facility were more likely to report dissatisfaction with the waiting time for requested diagnostic investigations (PR: 1.98, 95% CI: 1.20-3.28).Conclusion: A insignificant tendency to use ‘wait-and-see’ and ‘medical treatment’ were more likely in GPs of patients with long travel distance to the first diagnostic facility when the GP did not suspect cancer or serious illness. Long distance was associated with higher probability of GP dissatisfaction with the waiting time for diagnostic investigations.

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“…The tests used in the analysis were: a plain chest X-ray or lung computerised tomography (CT) for the lung vignette; a tumour marker, diagnostic ultrasound or CT for the ovarian vignette; an ultrasound of the breast or mammography for the breast vignette; and diagnostic ultrasound, sigmoidoscopy, colonoscopy or CT colonography for the colorectal vignette. A factor analysis of the results of the survey section on the effect of health system factors is reported separately(37).…”

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Primary care practitioner diagnostic action when the patient may have cancer: a vignette survey in 20 European countries

Harris

Brekke

Dinant

et al. 2019

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Background Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence Primary Care Practitioners’ (PCPs’) referral decisions in patients that could have cancer, and how this links with cancer survival. This study aimed to explore PCPs’ diagnostic actions in patients with symptoms that could be due to cancer, how they vary across European countries with marked differences in socio-economic development, healthcare investment and organisation, and how they relate to cancer survival rates. Methods A primary care study, with centres in twenty European countries with widely varying cancer survival rates. The on-line survey of PCPs used vignettes describing four patients with symptoms that could indicate cancer (lung, ovary, breast and colorectal). PCPs were asked how they would manage these patients. Correlations between the likelihood of taking immediate diagnostic action and physician characteristics were calculated. The likelihood of taking immediate diagnostic action in the different participating countries was also analysed, as well as the correlation with national 1-year relative cancer survival rates. Results A total of 2,086 PCPs answered the survey question, with a median of 72 PCPs per country. PCPs’ likelihood of organising a diagnostic test and/or referring to a specialist at the first consultation varied from 50 to 82% between countries PCPs who were more experienced, were working in more remote areas, or worked alone or in smaller practices, were more likely to take immediate diagnostic action than their peers. There was a significant negative correlation between national healthcare expenditure levels and likelihood of immediate diagnostic action (r=–0.55, P=0.012). However, there was no significant correlation between the likelihood of taking immediate diagnostic action and cancer survival (r=–0.27, P=0.278). Conclusions Europe shows large between-country variations in PCPs’ diagnostic action rates for patients who could have cancer. These are linked with differences in healthcare organisation and levels of healthcare investment.

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Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross-sectional survey

Cited by 23 publications

References 35 publications

Cancer diagnosis in Scottish primary care: Results from the National Cancer Diagnosis Audit

Cancer diagnosis in Scottish primary care: Results from the National Cancer Diagnosis Audit

Patient’s travel distance to specialised cancer diagnostics and the association with the general practitioner’s diagnostic strategy and satisfaction with the access to diagnostic procedures: an observational study in Denmark

Primary care practitioner diagnostic action when the patient may have cancer: a vignette survey in 20 European countries

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