TY - JOUR
T1 - Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion
T2 - a European cross-sectional survey
AU - Harris, Michael
AU - Vedsted, Peter
AU - Esteva, Magdalena
AU - Murchie, Peter
AU - Aubin-Auger, Isabelle
AU - Azuri, Joseph
AU - Brekke, Mette
AU - Buczkowski, Krzysztof
AU - Buono, Nicola
AU - Costiug, Emiliana
AU - Dinant, Geert-Jan
AU - Foreva, Gergana
AU - Babic, Svjetlana Gasparovic
AU - Hoffman, Robert
AU - Jakob, Eva
AU - Koskela, Tuomas H.
AU - Marzo-Castillejo, Merce
AU - Neves, Ana Luisa
AU - Petek, Davorina
AU - Ster, Marija Petek
AU - Sawicka-Powierza, Jolanta
AU - Schneider, Antonius
AU - Smyrnakis, Emmanouil
AU - Streit, Sven
AU - Thulesius, Hans
AU - Weltermann, Birgitta
AU - Taylor, Gordon
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
KW - delivery of health care
KW - primary health care
KW - general practitioners
KW - cancer
KW - decision making
KW - consultation and referral
KW - LONG-TERM
KW - DIAGNOSIS
KW - SURVIVAL
KW - TIMES
KW - INTERVALS
KW - OUTCOMES
KW - WOMEN
KW - DELAY
U2 - 10.1136/bmjopen-2018-022904
DO - 10.1136/bmjopen-2018-022904
M3 - Article
C2 - 30185577
SN - 2044-6055
VL - 8
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - 022904
ER -