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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, (författare)
University of Bath, UK;University of Bern, Switzerland
Vedsted, Peter, (författare)
Aarhus University, Denmark
Esteva, Magdalena, (författare)
Balearic Islands Health Research Institute (IdISBa), Spain
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Murchie, Peter, (författare)
University of Aberdeen, UK
Aubin-Auger, Isabelle, (författare)
Université Paris Diderot, France
Azuri, Joseph, (författare)
Tel Aviv University, Israel
Brekke, Mette, (författare)
University of Oslo, Norway
Buczkowski, Krzysztof, (författare)
Nicolaus Copernicus University, Poland
Buono, Nicola, (författare)
National Society of Medical Education in General Practice (SNaMID), Italy
Costiug, Emiliana, (författare)
Iuliu Hatieganu University of Medicine and Pharmacy, Romania
Dinant, Geert-Jan, (författare)
Maastricht University, Netherlands
Foreva, Gergana, (författare)
Medical Center BROD, Plovdiv, Bulgaria
Gašparović Babić, Svjetlana, (författare)
The Teaching Institute of Public Health of Primorsko-goranska County, Croatia
Hoffman, Robert, (författare)
Tel Aviv University, Israel
Jakob, Eva, (författare)
Centro de Saúde Sarria, Spain
Koskela, Tuomas H, (författare)
University of Tampere, Finland
Marzo-Castillejo, Mercè, (författare)
Institut Catala De La Salut, Spain
Neves, Ana Luísa, (författare)
Imperial College London, UK;University of Porto, Porto, Portugal
Petek, Davorina, (författare)
University of Ljubljana, Slovenia
Petek Ster, Marija, (författare)
University of Ljubljana, Slovenia
Sawicka-Powierza, Jolanta, (författare)
Medical University of Bialystok, Poland
Schneider, Antonius, (författare)
Technische Universität München, Germany
Smyrnakis, Emmanouil, (författare)
Aristotle University of Thessaloniki, Greece
Streit, Sven, (författare)
University of Bern, Switzerland
Thulesius, Hans, (författare)
Lund University, Sweden
Weltermann, Birgitta, (författare)
University of Bonn, Germany
Taylor, Gordon, (författare)
University of Bath, UK
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Ingår i: BMJ Open. - BMJ Publishing Group Ltd. - 2044-6055. ; 8:9, s. 1-13
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
  • 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.


MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)


consultation and referral
decision making
delivery of health care
general practitioners
primary health care

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