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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, University of Bern
Vedsted, Peter, (författare)
Aarhus University
Esteva, Magdalena, (författare)
Instituto de Investigación sanitaria Illes Balears (idISBA)
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Murchie, Peter, (författare)
University of Aberdeen
Aubin-Auger, Isabelle, (författare)
Paris Diderot University
Azuri, Joseph, (författare)
Tel-Aviv University
Brekke, Mette, (författare)
University of Oslo
Buczkowski, Krzysztof, (författare)
Nicolaus Copernicus University
Buono, Nicola, (författare)
National Italian Society of Medical Education In General Practice
Costiug, Emiliana, (författare)
University of Medicine and Pharmacy, Cluj-Napoca
Dinant, Geert Jan, (författare)
Maastricht University
Foreva, Gergana, (författare)
Medical Center BROD
Gašparović Babić, Svjetlana, (författare)
University of Rijeka
Hoffman, Robert, (författare)
Tel-Aviv University
Jakob, Eva (författare)
Koskela, Tuomas H., (författare)
University of Tampere
Marzo-Castillejo, Mercè, (författare)
Institut Universitari d’Investigació en Atenció Primària Jordi Gol
Neves, Ana Luísa, (författare)
University of Porto, Imperial College London
Petek, Davorina, (författare)
University of Ljubljana
Petek Ster, Marija, (författare)
University of Ljubljana
Sawicka-Powierza, Jolanta, (författare)
Medical University of Bialystok
Schneider, Antonius (författare)
Smyrnakis, Emmanouil, (författare)
Aristotle University of Thessaloniki
Streit, Sven, (författare)
University of Bern
Thulesius, Hans, (författare)
Forskargrupper vid Lunds universitet, Lund University Research Groups, Lunds universitet, Lund University, Allmänmedicin och samhällsmedicin, Family Medicine and Community Medicine
Weltermann, Birgitta, (författare)
University of Bonn
Taylor, Gordon, (författare)
University of Bath
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Ingår i: BMJ Open. - British Medical Journal Publishing Group. - 2044-6055. ; 8:9
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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  -- 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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