How the probability of presentation to a primary care clinician correlates with cancer survival rates

a European survey using vignettes

Michael Harris, Peter Frey, Magdalena Esteva, Svjetlana Gašparović Babić, Mercè Marzo-Castillejo, Davorina Petek, Marija Petek Ster, Hans Thulesius

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting: A total of 14 countries. Subjects: Consensus groups of PCPs. Main outcome measures: Probability of initial presentation to a PCP for four clinical vignettes. Results: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r = −0.16, 95% CI−0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI−0.83 to−0.12; ovary: r = −0.13, 95% CI−0.57 to 0.38; breast r = 0.14, 95% CI−0.36 to 0.58; bowel: r = 0.20, 95% CI−0.31 to 0.62). Conclusions: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival.KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

Original languageEnglish
Pages (from-to)27-34
Number of pages8
JournalScandinavian Journal of Primary Health Care
Volume35
Issue number1
DOIs
Publication statusPublished - 2 Jan 2017

Fingerprint

Primary Care Physicians
Primary Health Care
Survival Rate
Neoplasms
Survival
Surveys and Questionnaires
Gatekeeping
Ovary
Lung Neoplasms
Breast
Referral and Consultation
Outcome Assessment (Health Care)
Lung

Keywords

  • cancer
  • decision making
  • diagnosis
  • Europe
  • Health care systems
  • primary health care

Cite this

How the probability of presentation to a primary care clinician correlates with cancer survival rates : a European survey using vignettes. / Harris, Michael; Frey, Peter; Esteva, Magdalena; Gašparović Babić, Svjetlana; Marzo-Castillejo, Mercè; Petek, Davorina; Petek Ster, Marija; Thulesius, Hans.

In: Scandinavian Journal of Primary Health Care, Vol. 35, No. 1, 02.01.2017, p. 27-34.

Research output: Contribution to journalArticle

Harris, Michael ; Frey, Peter ; Esteva, Magdalena ; Gašparović Babić, Svjetlana ; Marzo-Castillejo, Mercè ; Petek, Davorina ; Petek Ster, Marija ; Thulesius, Hans. / How the probability of presentation to a primary care clinician correlates with cancer survival rates : a European survey using vignettes. In: Scandinavian Journal of Primary Health Care. 2017 ; Vol. 35, No. 1. pp. 27-34.
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abstract = "Objective: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting: A total of 14 countries. Subjects: Consensus groups of PCPs. Main outcome measures: Probability of initial presentation to a PCP for four clinical vignettes. Results: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r = −0.16, 95{\%} CI−0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95{\%} CI−0.83 to−0.12; ovary: r = −0.13, 95{\%} CI−0.57 to 0.38; breast r = 0.14, 95{\%} CI−0.36 to 0.58; bowel: r = 0.20, 95{\%} CI−0.31 to 0.62). Conclusions: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival.KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.",
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AU - Frey, Peter

AU - Esteva, Magdalena

AU - Gašparović Babić, Svjetlana

AU - Marzo-Castillejo, Mercè

AU - Petek, Davorina

AU - Petek Ster, Marija

AU - Thulesius, Hans

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N2 - Objective: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting: A total of 14 countries. Subjects: Consensus groups of PCPs. Main outcome measures: Probability of initial presentation to a PCP for four clinical vignettes. Results: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r = −0.16, 95% CI−0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI−0.83 to−0.12; ovary: r = −0.13, 95% CI−0.57 to 0.38; breast r = 0.14, 95% CI−0.36 to 0.58; bowel: r = 0.20, 95% CI−0.31 to 0.62). Conclusions: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival.KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

AB - Objective: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting: A total of 14 countries. Subjects: Consensus groups of PCPs. Main outcome measures: Probability of initial presentation to a PCP for four clinical vignettes. Results: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r = −0.16, 95% CI−0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI−0.83 to−0.12; ovary: r = −0.13, 95% CI−0.57 to 0.38; breast r = 0.14, 95% CI−0.36 to 0.58; bowel: r = 0.20, 95% CI−0.31 to 0.62). Conclusions: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival.KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

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KW - decision making

KW - diagnosis

KW - Europe

KW - Health care systems

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