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

Abstract

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.