Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross- sectional survey

Michael Harris, Peter Vedsted, Magdalena Esteva, Peter Murchie, Isabelle Aubin-Auger, Joseph Azuri, Mette Brekke, Krzysztof Buczkowski, Nicola Buono, Emiliana Costiug, Geert-Jan Dinant, Gergana Foreva, Svjetlana Gasparovic Babic, Robert Hoffman, Eva Jakob, Tuomas H. Koskela, Merce Marzo-Castillejo, Ana Luisa Neves, Davorina Petek, Marija Petek Ster & 7 others Jolanta Sawicka-Powierza, Antonius Schneider, Emmanouil Smyrnakis, Sven Streit, Hans Thulesius, Brigitta Weltermann, Gordon Taylor

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Article numbere022904
Pages (from-to)1-13
Number of pages13
JournalBMJ Open
Volume8
Issue number9
Early online date5 Sep 2018
DOIs
Publication statusPublished - 5 Sep 2018

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Primary Health Care
Referral and Consultation
Cross-Sectional Studies
Health
Neoplasms
Decision Making
Statistical Factor Analysis
Secondary Care
Aptitude
Health Policy
Health Services
Consensus
Outcome Assessment (Health Care)
Delivery of Health Care
Pressure
Costs and Cost Analysis
Survival

Keywords

  • Delivery of Health Care
  • Primary Health Care
  • General Practitioners
  • Cancer
  • Decision Making
  • Consultation and Referral

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Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross- sectional survey. / Harris, Michael; Vedsted, Peter; Esteva, Magdalena; Murchie, Peter; Aubin-Auger, Isabelle; Azuri, Joseph; Brekke, Mette; Buczkowski, Krzysztof; Buono, Nicola; Costiug, Emiliana; Dinant, Geert-Jan; Foreva, Gergana; Gasparovic Babic, Svjetlana; Hoffman, Robert; Jakob, Eva; Koskela, Tuomas H.; Marzo-Castillejo, Merce; Neves, Ana Luisa; Petek, Davorina; Petek Ster, Marija; Sawicka-Powierza, Jolanta; Schneider, Antonius; Smyrnakis, Emmanouil; Streit, Sven; Thulesius, Hans; Weltermann, Brigitta; Taylor, Gordon.

In: BMJ Open, Vol. 8, No. 9, e022904, 05.09.2018, p. 1-13.

Research output: Contribution to journalArticle

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, Gasparovic Babic, 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 2018, 'Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross- sectional survey', BMJ Open, vol. 8, no. 9, e022904, pp. 1-13. https://doi.org/10.1136/bmjopen-2018-022904
Harris, Michael ; Vedsted, Peter ; Esteva, Magdalena ; Murchie, Peter ; Aubin-Auger, Isabelle ; Azuri, Joseph ; Brekke, Mette ; Buczkowski, Krzysztof ; Buono, Nicola ; Costiug, Emiliana ; Dinant, Geert-Jan ; Foreva, Gergana ; Gasparovic Babic, Svjetlana ; Hoffman, Robert ; Jakob, Eva ; Koskela, Tuomas H. ; Marzo-Castillejo, Merce ; Neves, Ana Luisa ; Petek, Davorina ; Petek Ster, Marija ; Sawicka-Powierza, Jolanta ; Schneider, Antonius ; Smyrnakis, Emmanouil ; Streit, Sven ; Thulesius, Hans ; Weltermann, Brigitta ; Taylor, Gordon. / Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross- sectional survey. In: BMJ Open. 2018 ; Vol. 8, No. 9. pp. 1-13.
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abstract = "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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T1 - Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross- sectional survey

AU - Harris, Michael

AU - Vedsted, Peter

AU - Esteva, Magdalena

AU - Murchie, Peter

AU - Aubin-Auger, Isabelle

AU - Azuri, Joseph

AU - Brekke, Mette

AU - Buczkowski, Krzysztof

AU - Buono, Nicola

AU - Costiug, Emiliana

AU - Dinant, Geert-Jan

AU - Foreva, Gergana

AU - Gasparovic Babic, Svjetlana

AU - Hoffman, Robert

AU - Jakob, Eva

AU - Koskela, Tuomas H.

AU - Marzo-Castillejo, Merce

AU - Neves, Ana Luisa

AU - Petek, Davorina

AU - Petek Ster, Marija

AU - Sawicka-Powierza, Jolanta

AU - Schneider, Antonius

AU - Smyrnakis, Emmanouil

AU - Streit, Sven

AU - Thulesius, Hans

AU - Weltermann, Brigitta

AU - Taylor, Gordon

N1 - © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2018/9/5

Y1 - 2018/9/5

N2 - 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.

AB - 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.

KW - Delivery of Health Care

KW - Primary Health Care

KW - General Practitioners

KW - Cancer

KW - Decision Making

KW - Consultation and Referral

U2 - 10.1136/bmjopen-2018-022904

DO - 10.1136/bmjopen-2018-022904

M3 - Article

VL - 8

SP - 1

EP - 13

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 9

M1 - e022904

ER -