The Örenäs Research Group

Project: Other

Project Details


Michael Harris leads the Örenäs Research Group (ÖRG), a European collaborative group of primary care researchers. The ÖRG was formed in 2013 to study the factors influencing national variations in the early diagnosis of cancer in primary care.
The ÖRG has collaborators in 51 academic and clinical centres in 29 countries: Austria, Bulgaria, Croatia, Czech Republic, Denmark, England, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Israel, Italy, Latvia, Lithuania, Netherlands, Norway, Poland, Portugal, Romania, Scotland, Slovenia, Spain, Sweden, Switzerland, Turkey and Ukraine.
Why are we researching this subject?
One-year relative cancer survival rates vary widely across European countries – from 58.2% to 81.1%. It is thought that this variation is due to differences in timeliness of cancer diagnosis in those countries.
As an example of the impact that this has, the United Kingdom’s (UK’s) record in cancer mortality is poor compared with most other western-European countries. It is estimated that 6-7,000 lives are lost each year in the UK from late cancer diagnosis, compared with the mean survival in other Europe countries.
Primary care is the main setting where cancer is diagnosed, or at least suspected. In spite of an increase in cancer diagnosis research in recent years, choosing which patients need to be investigated or referred to a specialist continues to be complex, and influenced by such issues as national policy and local availability of access to investigation by primary care doctors.
However, there has been little research done to explain how different national systems influence a primary care doctor’s referral decisions, and how these result in such a variable survival rate.
What do we do?
The ÖRG works to provide an understanding of the interactions between health system factors and professional behaviour, so that cancer survival outcomes can be improved.
Who is the Örenäs Research Group’s lead?
Michael Harris is the ÖRG’s lead and coordinator.
Where does the Örenäs Research Group meet?
The ÖRG has held five 3-day residential workshops:
• 2013: Örenäs, Sweden
• 2014: Barcelona, Spain
• 2017: Bath, UK
• 2018: Ljubljana, Slovenia
• 2019: Palma, Mallorca, Spain
We also have short meetings every six months at European GP Research Network (EGPRN) conferences.
Recent projects
In 2013 we had funding from the European Science Foundation to run an 8-country workshop to plan our approach to this research area.
• We used this meeting to frame our research questions, get insight into other European health-care systems, form connections and new collaborations, and formulate a research plan.
• The meeting took place at Örenäs in Sweden, and this gave the newly-formed collaborative group its name.
In our 2014 workshop, we identified the system and other non-clinical factors that may influence a primary care doctor’s decision on whether to refer a patient who may have cancer.
• Many non-clinical factors were considered to be likely to have a significant impact on referral decisions.
• These included levels of gatekeeping responsibility, funding systems, access to special investigations, fear of litigation, and relationships with specialist colleagues. (Harris, Frey, Esteva et al 2016)
An Örenäs Research Group study in 2016 used patient vignettes (cases where the patients could have early cancer) to examine how probability of presentation to a primary care clinician correlates with national cancer survival rates.
• The study found that the degree to which primary care doctor act as gatekeepers varies considerably from country to country.
• There was no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival. (Harris, Frey, Esteva et al 2017)
We completed a survey of over 2000 GPs and other primary care practitioners in 20 European countries in 2017. (Harris, Taylor, Örenäs Research Group 2018).
• Five healthcare system factors influencing PCPs’ referral decision-making in 20 European countries were identified. These factors varied considerably between European countries.
• Knowledge of these factors should assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes. (Harris M, Vedsted P, Esteva M, et al 2018)
Our recent research output includes:
• A qualitative study on how European GPs think the speed of diagnosis of cancer in primary care could be improved (Harris M, Thulesius H, Neves AL et al, 2019).
• A study on the availability of diagnostic ultrasound in primary care (Andersen CA, Jensen MBB, Toftegaard BS et al, 2019)
• A comparison of rural and urban GPs’ cancer diagnostic decision-making (Murchie P, Khor WL, Adam R et al, 2020).
• An investigation into GPs’ diagnostic action when faced with patients that may have cancer (Harris M, Vedsted P, Esteva M et al, 2020).
Current projects
We are working on two new research studies:
• What factors inhibit a GP’s thinking of cancer as a possible diagnosis in a symptomatic patient?
• What factors affect GPs’ empowerment in their decision-making in patients who might have cancer?
Örenäs Research Group publications
Andersen CA, Jensen MBB, Toftegaard BS, Vedsted P, Harris M, Örenäs Research Group (2019) Primary care physicians’ access to in-house ultrasound examinations across Europe: a questionnaire study. BMJ Open 9: e030958, doi:10.1136/bmjopen-2019-030958.
Harris M, Brekke M, Dinant G-J, Esteva M, Hoffman R, Marzo-Castillejo M, Murchie P, Neves AL, Smyrnakis E, Vedsted P, Aubin-Auger I, Azuri J, Buczkowski K, Buono N, Foreva G, Babić SG, Jacob E, Koskela T, Petek D, Šter MP, Puia A, Sawicka-Powierza J, Streit S, Thulesius H, Weltermann B, Taylor G (2020) Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries. BMJ Open 10: e035678, doi:10.1136/bmjopen-2019-035678.
Harris M, Frey P, Esteva M, Gašparović Babić S, Marzo-Castillejo M, Petek D, Petek Ster M, Thulesius H (2017) How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes. Scand J Prim Health Care 27–34, doi:10.1080/02813432.2017.1288692.
Harris M, Frey P, Esteva M, Gašparović-Babić S, Marzo-Castillejo M, Petek D, Petek Ster M, Thulesius H (2016) How health system factors influence referral decisions in patients that may have cancer: European symposium report. J Cancer Res Ther 4(1): 7–10, doi:10.14312/2052-4994.2016-2.
Harris M, Taylor G, Örenäs Research Group (2018a) How health system factors affect primary care practitioners’ decisions to refer patients for further investigation: protocol for a pan-European ecological study. BMC Health Serv Res 18: 338, doi:10.1186/s12913-018-3170-2.
Harris M, Thulesius H, Neves AL, Harker S, Koskela T, Petek D, Hoffman R, Brekke M, Buczkowski K, Buono N, Costiug E, Dinant G-J, Foreva G, Jakob E, Marzo M, Murchie P, Sawicka-Powierza J, Schneider A, Smyrnakis E, Streit S, Taylor G, Vedsted P, Weltermann B, Esteva M (2019) How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis. BMJ Open 9: e030169, doi:10.1136/bmjopen-2019-030169.
Harris M, Vedsted P, Esteva M, Murchie P, Aubin-Auger I, Azuri J, Brekke M, Buczkowski K, Buono N, Costiug E, Dinant G-J, Foreva G, Gašparović Babić S, Hoffman R, Jakob E, Koskela TH, Marzo-Castillejo M, Neves AL, Petek D, Petek Ster M, Sawicka-Powierza J, Schneider A, Smyrnakis E, Streit S, Thulesius H, Weltermann B, Taylor G (2018b) Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross-sectional survey. BMJ Open 8: doi:10.1136/bmjopen-2018-022904.
Murchie P, Khor WL, Adam R, Esteva M, Smyrnakis E, Petek D, Thulesius H, Vedsted P, McLernon D, Harris M (2020) Influences of rurality on action to diagnose cancer by primary care practitioners – Results from a Europe-wide survey in 20 countries. Cancer Epidemiology 65: 101698, doi:10.1016/j.canep.2020.101698.
For further information about the Örenäs Research Group, please contact Michael Harris.
Tel: +44 (0) 1761 241366 email:
Effective start/end date1/01/15 → …