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How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis.

ABSTRACT: BACKGROUND:National European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis. OBJECTIVES:This study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagnosis could be improved. DESIGN:In an online survey, a final open-ended question asked PCPs how they thought the speed of diagnosis of cancer in primary care could be improved. Thematic analysis was used to analyse the data. SETTING:A primary care study, with participating centres in 20 European countries. PARTICIPANTS:A total of 1352 PCPs answered the final survey question, with a median of 48 per country. RESULTS:The main themes identified were: patient-related factors, including health education; care provider-related factors, including continuing medical education; improving communication and interprofessional partnership, particularly between primary and secondary care; factors relating to health system organisation and policies, including improving access to healthcare; easier primary care access to diagnostic tests; and use of information technology. Re-allocation of funding to support timely diagnosis was seen as an issue affecting all of these. CONCLUSIONS:To achieve more timely cancer diagnosis, health systems need to facilitate earlier patient presentation through education and better access to care, have well-educated clinicians with good access to investigations and better information technology, and adequate primary care cancer diagnostic pathway funding.

SUBMITTER: Harris M

PROVIDER: S-EPMC6773305 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis.

Harris Michael M Thulesius Hans H Neves Ana Luísa AL Harker Sophie S Koskela Tuomas T Petek Davorina D Hoffman Robert R Brekke Mette M Buczkowski Krzysztof K Buono Nicola N Costiug Emiliana E Dinant Geert-Jan GJ Foreva Gergana G Jakob Eva E Marzo-Castillejo Mercè M Murchie Peter P Sawicka-Powierza Jolanta J Schneider Antonius A Smyrnakis Emmanouil E Streit Sven S Taylor Gordon G Vedsted Peter P Weltermann Birgitta B Esteva Magdalena M

BMJ open 20190924 9

<h4>Background</h4>National European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis.<h4>Objectives</h4>This study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagno ...[more]

PMID: 31551382

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Project description: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.

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How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis.

Publications

How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis.

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