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How do general practitioners manage patients with cancer symptoms? A video-vignette study
  1. Moyez Jiwa1,
  2. Xingqiong Meng2,
  3. Carolyn O'Shea3,
  4. Parker Magin4,
  5. Ann Dadich5,
  6. Vinita Pillai6
  1. 1Melbourne Clinical School, School of Medicine Sydney, University of Notre Dame, Werribee, Victoria, Australia
  2. 2School of Medicine, Flinders University, Adelaide, South Australia, Australia
  3. 3Victorian Metropolitan Alliance, Hawthorn, Victoria, Australia
  4. 4Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia
  5. 5School of Business, University of Western Sydney, Parramatta, New South Wales, Australia
  6. 6Department of Medical Education, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Professor Moyez Jiwa; moyez.jiwa{at}


Objectives Determine how general practitioners (GPs) manage patients with cancer symptoms.

Design GPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to available guidelines, all cases warranted a referral to a specialist or further investigations.

Setting Australian primary care sector.

Participants 102 practising GPs participated in this study, including trainees.

Interventions The research was part of a larger randomised controlled trial testing a referral pro forma; however, this paper reports on management decisions made throughout the study.

Primary and secondary outcome measures This paper reports on how the participants would manage the patients depicted in each vignette.

Results In more than one-in-eight cases, the patient was not investigated or referred. Patient management varied significantly by cancer type (p<0.001). For two key reasons, colorectal cancer was the chosen referent category. First, it represents a prevalent type of cancer. Second, in this study, colorectal cancer symptoms were managed in a similar proportion of options—that is, prescription, referral or investigation. Compared with vignettes featuring colorectal cancer participants were less likely to manage breast, bladder, endometrial, and lung cancers with a ‘prescription only’ or ‘referral only’ option. They were less likely to manage prostate cancer with a ‘prescription only’, yet more likely to manage it with a ‘referral with investigation’. With regard to pancreatic and cervical cancers, participants were more likely to manage these with a ‘referral only’ or a ‘referral with investigation’.

Conclusions Some patients may receive a delayed cancer diagnosis, even when they present with typical cancer symptoms to a GP who can access relevant diagnostic tests.

Trial registration number ACTRN12611000760976.


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