Abstract
Objectives
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.
This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries.
Design
A primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated.
Setting
Centres in twenty European countries with widely varying cancer survival rates.
Participants
A total of 2,086 PCPs answered the survey question, with a median of 72 PCPs per country.
Results
PCPs’ likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers.
Conclusions
When given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.
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.
This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries.
Design
A primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated.
Setting
Centres in twenty European countries with widely varying cancer survival rates.
Participants
A total of 2,086 PCPs answered the survey question, with a median of 72 PCPs per country.
Results
PCPs’ likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers.
Conclusions
When given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.
| Original language | English |
|---|---|
| Article number | e035678 |
| Number of pages | 10 |
| Journal | BMJ Open |
| Volume | 10 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 31 Oct 2020 |
Bibliographical note
Availability of dataTo avoid the risk of identification of individual participants, the datasets generated and analysed during the current study are not publicly available. However, they are available (with any possible identifying information redacted) from the corresponding author on reasonable request.
Funding
This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. ALN’s time is supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre, with her infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC).
Acknowledgements
We would like to thank all the PCPs who piloted the questionnaire and those who completed the survey. We would also like to thank the European GP Research Network for its support. We are grateful to Prof. Barbara Silverman and Prof. Lital Keinan for the data on cancer survival rates in Israel, and to Dr Yochai Schonmann for his work on those data. Two of the vignettes were used by kind permission of the ICBP; we also thank Dr Peter Murchie and Dr Rhona Auckland, who generously provided the other two vignettes. Prof. Antonius Schneider kindly organised the Technical University of Munich’s data collection.
Keywords
- Delivery of Health Care
- Primary Health Care
- Cancer
- Decision Making
- Survival
- Europe
- international health services
- adult oncology
- primary care
Access to Document
- Harris_et_al_BMJOpen_PrimaryCarePractitioners_VoR
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.