Primary care practitioners' diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries

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  • Michael Harris, University of Bath, University of Bern
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  • Mette Brekke, University of Oslo
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  • Geert Jan Dinant, Maastricht University
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  • Magdalena Esteva, Fundació Institut d'Investigació Sanitària Illes Balears
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  • Robert Hoffman, Tel Aviv University
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  • Mercè Marzo-Castillejo, Institut Universitari d’Investigació en Atenció Primària Jordi Gol
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  • Peter Murchie, University of Aberdeen
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  • Ana Luísa Neves, Imperial College London, University of Porto
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  • Emmanouil Smyrnakis, Aristotle University of Thessaloniki
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  • Peter Vedsted
  • Isabelle Aubin-Auger, Paris Descartes University
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  • Joseph Azuri, Tel Aviv University
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  • Krzysztof Buczkowski, Nicolaus Copernicus University in Torun
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  • Nicola Buono, National Society of Medical Education in General Practice (SNaMID)
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  • Gergana Foreva, Medical Center BROD
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  • Svjetlana Gašparović Babić, Croatian Health Insurance Fund
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  • Eva Jacob, Centro de Salud de Sarria
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  • Tuomas Koskela, Tampere University
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  • Davorina Petek, University of Ljubljana
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  • Marija Petek Šter, University of Ljubljana
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  • Aida Puia, Iuliu Hatieganu University of Medicine and Pharmacy
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  • Jolanta Sawicka-Powierza, Medical University of Bialystok
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  • Sven Streit, University of Bern
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  • Hans Thulesius, Lund University
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  • Birgitta Weltermann, University of Bonn
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  • Gordon Taylor, University of Exeter

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.

OriginalsprogEngelsk
Artikelnummere035678
TidsskriftBMJ Open
Vol/bind10
Nummer10
Antal sider10
ISSN2044-6055
DOI
StatusUdgivet - okt. 2020

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