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
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/.
Statistics from Altmetric.com
Twitter @CAPCAberdeen, @Sven_Streit
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.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.