Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion: a European cross-sectional survey.

Harris, Michael; Vedsted, Peter; Esteva, Magdalena; Murchie, Peter; Aubin-Auger, Isabelle; Azuri, Joseph; Brekke, Mette; Buczkowski, Krzysztof; Buono, Nicola; Costiug, Emiliana; Dinant, Geert-Jan; Foreva, Gergana; Gašparović Babić, Svjetlana; Hoffman, Robert; Jakob, Eva; Koskela, Tuomas H; Marzo-Castillejo, Mercè; Neves, Ana Luísa; Petek, Davorina; Petek Ster, Marija; ... (2018). Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion: a European cross-sectional survey. BMJ open, 8(9), e022904. BMJ Publishing Group 10.1136/bmjopen-2018-022904

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OBJECTIVES Cancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners' (PCPs') referral decisions is lacking.This study analyses health system factors potentially influencing PCPs' referral decision-making when consulting with patients who may have cancer, and how these vary between European countries. DESIGN Based on a content-validity consensus, a list of 45 items relating to a PCP's decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs' referral decision-making. SETTING A primary care study; 25 participating centres in 20 European countries. PARTICIPANTS 1830 PCPs completed the survey. The median response rate for participating centres was 20.7%. OUTCOME MEASURES The factors derived from items related to PCPs' referral decision-making. Mean factor scores were produced for each country, allowing comparisons. RESULTS Factor analysis identified five underlying factors: PCPs' ability to refer; degree of direct patient access to secondary care; PCPs' perceptions of being under pressure; expectations of PCPs' role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses. CONCLUSIONS Five healthcare system factors influencing PCPs' referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Harris, Michael Frank and Streit, Sven

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2044-6055

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

12 Sep 2018 14:58

Last Modified:

04 Oct 2018 09:54

Publisher DOI:

10.1136/bmjopen-2018-022904

PubMed ID:

30185577

Uncontrolled Keywords:

cancer consultation and referral decision making delivery of health care general practitioners primary health care

BORIS DOI:

10.7892/boris.119934

URI:

https://boris.unibe.ch/id/eprint/119934

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