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Original research
Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries
  1. Michael Harris1,2,
  2. Mette Brekke3,
  3. Geert-Jan Dinant4,
  4. Magdalena Esteva5,
  5. Robert Hoffman6,
  6. Mercè Marzo-Castillejo7,
  7. Peter Murchie8,
  8. Ana Luísa Neves9,10,
  9. Emmanouil Smyrnakis11,
  10. Peter Vedsted12,
  11. Isabelle Aubin-Auger13,
  12. Joseph Azuri14,
  13. Krzysztof Buczkowski15,
  14. Nicola Buono16,
  15. Gergana Foreva17,
  16. Svjetlana Gašparović Babić18,
  17. Eva Jacob19,
  18. Tuomas Koskela20,
  19. Davorina Petek21,
  20. Marija Petek Šter21,
  21. Aida Puia22,
  22. Jolanta Sawicka-Powierza23,
  23. Sven Streit2,
  24. Hans Thulesius24,
  25. Birgitta Weltermann25,
  26. Gordon Taylor26
  1. 1Department for Health, University of Bath, Bath, Somerset, UK
  2. 2Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
  3. 3Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway
  4. 4Department of General Practice, Maastricht University, Maastricht, The Netherlands
  5. 5Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Illes Balears, Spain
  6. 6Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
  7. 7Unitat de Suport a la Recerca Costa de Ponent, IDIAP Jordi Gol, Barcelona, Spain
  8. 8Division of Applied Health Science, University of Aberdeen, Aberdeen, UK
  9. 9Centre for Health Policy, Imperial College London, London, UK
  10. 10Centre for Health Technology and Services Research, Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
  11. 11Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
  12. 12Research Unit for General Practice, University of Aarhus, Aarhus, Denmark
  13. 13Department of General Practice, Université Paris Diderot, Paris, Île-de-France, France
  14. 14Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  15. 15Department of Family Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
  16. 16Department of Family Medicine, National Society of Medical Education in General Practice (SNaMID), Prata Sannita, Italy
  17. 17Medical Center BROD, Plovdiv, Bulgaria
  18. 18Croatian Health Insurance Fund, Rijeka, Croatia
  19. 19Primary Health Centre, Centro de Saúde Sarria, Sarria, Lugo, Spain
  20. 20Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  21. 21Department of Family Medicine, Univerza v Ljubljani, Ljubljana, Slovenia
  22. 22Family Medicine Department, Iuliu Hagieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
  23. 23Department of Family Medicine, Uniwersytet Medyczny w Bialymstoku, Bialystok, Poland
  24. 24Department of Research and Development, Lund University, Malmö, Sweden
  25. 25Institut für Hausarztmedizin, University of Bonn, Bonn, Nordrhein-Westfalen, Germany
  26. 26College of Medicine and Health, University of Exeter, Exeter, Devon, UK
  1. Correspondence to Professor Michael Harris; michaelharris681{at}


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 who 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 20 European countries with widely varying cancer survival rates.

Participants A total of 2086 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.

Conclusion 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.

  • international health services
  • adult oncology
  • primary care

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  • Contributors IA-A, JA, KB, MB, NB, G-JD, ME, GF, SGB, MH, RH, EJ, TK, MM, PM, ALN, AP, DP, MPS, JS-P, ES, SS, GT, HT, PV and BW participated in the study design. All authors except GT were involved in the data collection. All authors contributed to the manuscript and approved the final version. MH had overall responsibility for the study design, recruitment of local leads, analysis of data and interpretation of results. GT advised on the study design and the statistical analysis.

  • Funding 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).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study was given by the University of Bath Research Ethics Approval Committee for Health (approval date: 24 November 2014; REACH reference number: EP 14/15 66). Other countries’ study leads either achieved local ethical approval or gave statements that formal ethical approval was not needed in their jurisdictions (see supplemental file). Consent was implied by agreeing to take part in the survey.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement To 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 participants’ identifying information redacted) from the corresponding author on reasonable request.

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