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BMJ Open. 2015 May 27;5(5):e007212. doi: 10.1136/bmjopen-2014-007212.

Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey.

Author information

1
Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
2
School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton-on-Tees, UK.
3
Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
4
Department of Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.
5
Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
6
Knowledge Translation Research Network Health Services Research Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
7
School of Medicine, Dentistry and Biomedical Sciences-Centre for Public Health, Queen's University Belfast, Belfast, UK.
8
North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.
9
Department of General Practice, Primary Health Care Research Evaluation and Development, Carlton, Victoria, Australia.
10
Division of Continuing Professional Development, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
11
Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
12
Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
13
Department of Clinical Sciences, Kronoberg County Research Council, Växjö, Sweden.
14
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
15
Department of Cancer Epidemiology, Public Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
16
Primary Care Diagnostics, University of Exeter Medical School, Exeter, UK.

Abstract

OBJECTIVES:

The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences.

DESIGN:

A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer.

PARTICIPANTS:

2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate.

RESULTS:

4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables.

CONCLUSIONS:

We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer-either directly, or by specialist referral, to improve outcomes.

KEYWORDS:

HEALTH SERVICES ADMINISTRATION & MANAGEMENT; ONCOLOGY

PMID:
26017370
PMCID:
PMC4452748
DOI:
10.1136/bmjopen-2014-007212
[Indexed for MEDLINE]
Free PMC Article

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