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; Jolanta Sawicka-Powierza; Antonius Schneider; Emmanouil Smyrnakis; Sven Streit; Hans Thulesius; Brigitta Weltermann; Gordon Taylor

doi:10.1136/bmjopen-2018-022904

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 SterJolanta Sawicka-Powierza, Antonius Schneider, Emmanouil Smyrnakis, Sven Streit, Hans Thulesius, Brigitta Weltermann, Gordon Taylor

Department for Health

Research output: Contribution to journal › Article › peer-review

19 Citations (SciVal)

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 language	English
Article number	e022904
Pages (from-to)	1-13
Number of pages	13
Journal	BMJ Open
Volume	8
Issue number	9
Early online date	5 Sept 2018
DOIs	https://doi.org/10.1136/bmjopen-2018-022904
Publication status	Published - 5 Sept 2018

Bibliographical note

Keywords

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

UN SDGs

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

Access to Document

10.1136/bmjopen-2018-022904Licence: CC BY-NC

Örenäs Research Group: survey for GPs
Harris, M. (Creator), University of Bath, 5 Sept 2018
DOI: 10.15125/BATH-00486
Dataset

Cite this

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, T. H., Marzo-Castillejo, M., Neves, A. L., Petek, D., ... Taylor, G. (2018). Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross- sectional survey. BMJ Open, 8(9), 1-13. Article e022904. https://doi.org/10.1136/bmjopen-2018-022904

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

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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.",

keywords = "Delivery of Health Care, Primary Health Care, General Practitioners, Cancer, Decision Making, Consultation and Referral",

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

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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

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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.

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KW - Primary Health Care

KW - General Practitioners

KW - Cancer

KW - Decision Making

KW - Consultation and Referral

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DO - 10.1136/bmjopen-2018-022904

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JO - BMJ Open

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ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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Datasets

Örenäs Research Group: survey for GPs

Cite this