Dataset Information

Knowledge or noise? Making sense of General Practitioners' and Consultant use of 2-week-wait referrals for suspected cancer.

ABSTRACT:

Background

Early diagnosis and treatment of cancer is the goal of the 2-week-wait referral pathway (2WW). Variation exists between General Practice use of 2WW and rates of consultant reprioritisation of GP referral from routine to 2WW (Consultant Upgrade). We investigated variation in General Practice and Consultant Upgrade 2WW referral activity.

Methods

Data from 185?000 referrals and 29?000 cancers recorded between 2011 and 2013 from the Northern Ireland Cancer Waiting Time database (CaPPS) were analysed to ascertain standardised referral rate ratios, detection rate (DR) (=sensitivity) and conversion rate (CR) (=positive predictive value) for Practice 2WW referrals and Consultant Upgrade 2WW. Metrics were compared using Spearman's rank correlation co-efficients.

Results

There was consistency in Practice and Consultant Upgrade 2WW referral rates over time, though not for annual DR (Spearman's ?<0.37) or CR (Spearman's ?<0.26). Practice 2WW referral rates correlated negatively with CR and positively with DR while correlations between DR and CR were restricted to single-year comparisons in Practice 2WW. In Consultant Upgrade, 2WW CR and DR were strongly correlated but only when the same cancers were included in both rates.

Conclusions

Results suggest 'random case mix' explains previously reported associations between CR and DR with more 'hard to detect' cancers in some Practices than in others in a given year corresponding to lower DR and CR. Use of Practice and Consultant Upgrade 2WW referral metrics to gauge General Practice performance may be misleading.

SUBMITTER: Donnelly C

PROVIDER: S-EPMC5572170 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Publications

Knowledge or noise? Making sense of General Practitioners' and Consultant use of 2-week-wait referrals for suspected cancer.

Donnelly Conan C Hart Nigel N McCrorie Alan David AD Anderson Lesley L Donnelly Michael M Murchie Peter P Gavin Anna A

British journal of cancer 20170727 5

<h4>Background</h4>Early diagnosis and treatment of cancer is the goal of the 2-week-wait referral pathway (2WW). Variation exists between General Practice use of 2WW and rates of consultant reprioritisation of GP referral from routine to 2WW (Consultant Upgrade). We investigated variation in General Practice and Consultant Upgrade 2WW referral activity.<h4>Methods</h4>Data from 185 000 referrals and 29 000 cancers recorded between 2011 and 2013 from the Northern Ireland Cancer Waiting Time data ...[more]

PMID: 28751756

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Project description:IntroductionMost knowledge translation models pay relatively little attention to patient-held knowledge and are largely based on the premise that researchers and clinicians hold all valuable knowledge, and patients are passive recipients of such knowledge. Counter to this clinician- and researcher-centred lens is a growing interest and awareness of patients as experts in their health. While naturopathic medicine is described and experienced as a patient-centred system of traditional medicine, the position of patient-held knowledge is unclear particularly when considered alongside their use of other more objective forms of knowledge such as research evidence.MethodsThis international online cross-sectional survey aimed to explore naturopathic practitioners' perceptions of the value and contribution of patient-shared knowledge and information within the context of naturopathic clinical consultations.ResultsThe survey was completed by 453 naturopathic practitioners (response rate: 74.3%). Approximately two-thirds (68.2%) of respondents reported using information shared by the patient. Most rated 'information provided by the patient' as either 'extremely important' (60.7%) or 'very important' (31.4%) to patients. Highest levels of trust were reported for information provided by the patient ('completely': 9.9%; 'a lot': 53.6%). Most practitioners indicated they trusted knowledge and information derived from the patient's personal health history 'completely' (n = 79; 21.8%) or 'a lot' (n = 226; 62.4%) from the patient's perspective of living with a health condition ('completely' [n = 63, 17.4%]; 'a lot' [n = 224, 61.9%]). Patients were the highest ranked stakeholder group (mean: 1.5) perceived to influence NP use of patient experience of living with a health condition to inform clinical decision-making.ConclusionResearchers and policy makers are increasingly focused on the value of the 'expert patient' in clinical decision-making, yet health professionals' report challenges and, in some cases, resistance to meaningfully engaging with patient-shared knowledge in practice. However, our study has found patient-shared knowledge - inclusive of patient experience of their health condition - is among the knowledge used and trusted by naturopathic practitioners to inform their clinical decision-making. This study both offers insights into the knowledge translation behaviours of an under-researched health profession and provides a novel contribution to the wider aim of adopting patient-shared knowledge into clinical care more generally.

Dataset Information

Knowledge or noise? Making sense of General Practitioners' and Consultant use of 2-week-wait referrals for suspected cancer.

Background

Methods

Results

Conclusions

Publications

Knowledge or noise? Making sense of General Practitioners' and Consultant use of 2-week-wait referrals for suspected cancer.

Similar Datasets

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