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General practitioners’ clinical decision-making in patients that could have cancer: a vignette study comparing the Baltic states with four Nordic countries

  • Alexander Rosendahl
  • , Anet Vanaveski
  • , Liina Pilv-Toom
  • , Janis Blumfelds
  • , Vija Siliņa
  • , Mette Brekke
  • , Tuomas Koskela
  • , Aurimas Rapalavičius
  • , Hans Thulesius
  • , Peter Vedsted
  • , Michael Harris
  • University of Tartu
  • Riga Stradins University
  • University of Oslo
  • Tampere University of Technology
  • Lithuanian University of Health Sciences
  • Linnæus University
  • Aarhus University
  • University of Bern

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Relative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics. Design: A survey of GPs using clinical vignettes. Setting: General Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden. Subjects: General Practitioners. Outcome measures: A regional comparison of GPs’ stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%). Results: Of the 427 GPs that completed the questionnaire, those in the Baltic states, and GPs that were more experienced, were more likely to arrange a key diagnostic test and/or refer their patient to a specialist than those in Nordic Countries or who were less experienced (p < 0.001 for both measures). Neither GP sex nor practice location within a country showed a significant association with these measures. Conclusion: While relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs’ reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences.

Original languageEnglish
Pages (from-to)403-410
Number of pages8
JournalScandinavian Journal of Primary Health Care
Volume43
Issue number2
Early online date21 Jan 2025
DOIs
Publication statusPublished - 21 Jan 2025

Bibliographical note

Publisher Copyright:
© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Data Availability Statement

To avoid the risk of identification of individual participants or patients, the datasets generated and analysed during the current study are not publicly available. However, they are available (with any identifying information redacted) from the corresponding author on reasonable request.

Acknowledgements

The authors are grateful to all the GPs who participated in the study. We would also like to thank the European GP Research Network for its support, the ICBP for its permission to use some of its vignettes, and Gordon Taylor, Professor of Medical Statistics at the University of Exeter, UK, for his help with the statistical analysis.

Funding

None. The authors are grateful to all the GPs who participated in the study. We would also like to thank the European GP Research Network for its support, the ICBP for its permission to use some of its vignettes, and Gordon Taylor, Professor of Medical Statistics at the University of Exeter, UK, for his help with the statistical analysis.

Funders
ICBP

    UN SDGs

    This output contributes to the following UN Sustainable Development Goals (SDGs)

    1. SDG 3 - Good Health and Well-being
      SDG 3 Good Health and Well-being

    Keywords

    • Cancer
    • early diagnosis
    • general practice
    • geography
    • primary health care

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health

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