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- Title
International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data.
- Authors
Nicholson, B. D.; Mant, D.; Shinkins, B.; Rose, P. W.; Neal, R. D.; Hart, N.; Hamilton, W.; Rubin, G.; Nicholson, Brian D; Mant, David; Neal, Richard D; Hart, Nigel; Hamilton, Willie; Shinkins, Bethany; Rubin, Greg; Rose, Peter W
- Abstract
<bold>Background: </bold>Variation in cancer survival persists between comparable nations and appears to be due, in part, to primary care practitioners (PCPs) having different thresholds for acting definitively in response to cancer-related symptoms.<bold>Aim: </bold>To explore whether cancer guidelines, and adherence to them, differ between jurisdictions and impacts on PCPs' propensity to take definitive action on cancer-related symptoms.<bold>Design and Setting: </bold>A secondary analysis of survey data from six countries (10 jurisdictions) participating in the International Cancer Benchmarking Partnership.<bold>Method: </bold>PCPs' responses to five clinical vignettes presenting symptoms and signs of lung (n = 2), colorectal (n = 2), and ovarian cancer (n = 1) were compared with investigation and referral recommendations in cancer guidelines.<bold>Results: </bold>Nine jurisdictions had guidelines covering the two colorectal vignettes. For the lung vignettes, although eight jurisdictions had guidelines for the first, the second was covered by a Swedish guideline alone. Only the UK and Denmark had an ovarian cancer guideline. Survey responses of 2795 PCPs (crude response rate: 12%) were analysed. Guideline adherence ranged from 20-82%. UK adherence was lower than other jurisdictions for the lung vignette covered by the guidance (47% versus 58%; P <0.01) but similar (45% versus 46%) or higher (67% versus 38%; P <0.01) for the two colorectal vignettes. PCPs took definitive action least often when a guideline recommended a non-definitive action or made no recommendation. UK PCPs adhered to recommendations for definitive action less than their counterparts (P <0.01). There wasno association between jurisdictional guideline adherence and 1-year survival.<bold>Conclusion: </bold>Cancer guideline content is variable between similarly developed nations and poor guideline adherence does not explain differential survival. Guidelines that fail to cover high-risk presentations or that recommend non-definitive action may reduce definitive diagnostic action.
- Subjects
CANCER treatment; OVARIAN cancer; NATIONAL Institute for Health &; Care Excellence (Great Britain); CANCER patients; COMPUTED tomography; TUMOR diagnosis; COMPARATIVE studies; RESEARCH methodology; MEDICAL cooperation; MEDICAL protocols; PRIMARY health care; RESEARCH; RESEARCH funding; SURVEYS; SURVIVAL; TUMORS; WORLD health; DISEASE management; EVALUATION research; DISEASE incidence; RETROSPECTIVE studies; EARLY detection of cancer
- Publication
British Journal of General Practice, 2016, Vol 66, Issue 643, pe106
- ISSN
0960-1643
- Publication type
journal article
- DOI
10.3399/bjgp16X683449