Abstract
Abstract Objective: To identify the system and other non-clinical factors that may influence a General Practitioners’ decision on whether to refer a patient who may have cancer. Study design: Expert group discussion and consensus formation. Methods: A group of eight General Practitioner (GP) researchers from Croatia, England, Slovenia, Spain, Sweden and Switzerland used brainstorming to identify the non-clinical factors that could affect GPs’ decision-making when faced with patients that might have cancer. The group refined and came to a consensus on these factors. Results: Many non-clinical factors are likely to have a significant impact on referral decisions. These include levels of gatekeeping responsibility, funding systems, access to special investigations, fear of litigation, and relationships with specialist colleagues. Conclusions: Many patients with cancer present without red-flag symptoms, but nevertheless still cause a feeling of concern in their GPs. How a health system is organised is likely to influence on how GPs act on those concerns.
Highlights
There is wide variation in the cancer survival rates across Europe [1], and this leads to substantial excess mortality
Poor 1-year survival rates are generally taken to be an indicator of more advanced disease at diagnosis [3]
Eight General Practitioner (GP) researchers from six countries were invited to take part in a symposium designed to investigate how primary care factors influence the speed of cancer diagnosis
Summary
There is wide variation in the cancer survival rates across Europe [1], and this leads to substantial excess mortality. In Great Britain over 6,000 deaths a year that occurred within 5 years of diagnosis would have been avoided if survival in Britain had matched the mean for Europe [2, 3]; this represents 6-7% of its cancer-related mortality. Poor 1-year survival rates are generally taken to be an indicator of more advanced disease at diagnosis [3]. For those patients that survive at least a year after their initial cancer diagnosis, there is less national variation. While recent overall cancer survival trends show improvement [5], there is little narrowing in the differences between countries [6]
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