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.
| Original language | English |
|---|---|
| Article number | e030169 |
| Pages (from-to) | 1-10 |
| Number of pages | 10 |
| Journal | BMJ Open |
| Volume | 9 |
| Issue number | 9 |
| Early online date | 24 Sept 2019 |
| DOIs | |
| Publication status | Published - 24 Sept 2019 |
Bibliographical note
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Funding
This research has identified key features that PCPs believe would be necessary to improve the timeliness of cancer diagnosis in their patients, and a need for re-allocation of health system funding to allow these to happen. Health systems need to facilitate earlier patient presentation through health 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. Many PCPs play a crucial role at the centre of their patients’ care, and the breadth of their experience is reflected in their wide range of suggestions. This understanding should help to inform health service policy and research towards better cancer outcomes. The authors would like to thank all the PCPs who piloted the questionnaire and those who completed the survey. The authors would also like to thank the following non-author contributors: Isabelle Aubin-Auger (Université Paris Diderot, Paris, France), Joseph Azuri (Tel Aviv University, Tel Aviv, Israel), Svjetlana Gašparović Babić (The Teaching Institute of Public Health of Primorsko-goranska County, Rijeka, Croatia) and Marija Petek Šter (University of Ljubljana, Ljubljana, Slovenia). Correction notice This article has been corrected since it was published. Author name has been updated. Contributors KB, MB, NB, EC, G-JD, ME, GF, EJ, MH, RH, EJ, TK, MM-C, PM, ALN, DP, JS-P, AS, ES, SS, HT, PV and BW participated in the study design, piloting and data collection. GT participated in the study design. SH coded some of the data. ME and SH assisted in validated the coding. ME, MH, RH, TK, ALN, DP and HT worked together to agree the themes. MH had overall responsibility for the study design, recruitment of local leads, analysis of data and interpretation of results. All authors contributed to the writing and review of the manuscript and approved the final version. Funding This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. ALN is supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre, with infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). Competing interests None declared. Patient consent for publication Not required. Ethics approval Ethical approval for the study was given by the University of Bath Research Ethics Approval Committee for Health (approval date: 24 November 2014; REACH reference number: EP 14/15 66). Other countries’ study leads either achieved local ethical approval or gave statements that formal ethical approval was not needed in their jurisdictions. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available on reasonable request.
Keywords
- Cancer
- Consultation and Referral
- Delivery of Health Care
- Diagnosis
- General Practitioners
- Primary Health Care
ASJC Scopus subject areas
- General Medicine
