Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries

Michael Harris* (Corresponding Author), Mette Brekke, Geert-Jan Dinant, Magdalena Esteva, Robert D. Hoffman , Mercè Marzo-Castillejo, Peter Murchie, Ana Luísa Neves, Emmanouil Smyrnakis, Peter Vedsted, Isabelle Aubin-Auger, Joseph Azuri, Krzysztof Buczkowski, Nicola Buono, Gergana Foreva, Svjetlana Gašparović Babić, Eva Jakob, Tuomas Koskela, Davorina Petek, Marija Petek SterAida Puia, Jolanta Sawicka-Powierza, Sven Streit, Hans Thulesius, Birgitta Weltermann, Gordon Taylor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
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Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence Primary Care Practitioners’ (PCPs’) referral decisions in patients that could have cancer.
This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries.
A primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated.
Centres in twenty European countries with widely varying cancer survival rates.
A total of 2,086 PCPs answered the survey question, with a median of 72 PCPs per country.
PCPs’ likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers.
When given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.
Original languageEnglish
Article numbere035678
Number of pages10
JournalBMJ Open
Issue number10
Publication statusPublished - 31 Oct 2020

Bibliographical note

Availability of data
To avoid the risk of identification of individual participants, the datasets generated and analysed during the current study are not publicly available. However, they are available (with any possible identifying information redacted) from the corresponding author on reasonable request.

This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. ALN’s time is supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre, with her infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC).

We would like to thank all the PCPs who piloted the questionnaire and those who completed the survey. We would also like to thank the European GP Research Network for its support. We are grateful to Prof. Barbara Silverman and Prof. Lital Keinan for the data on cancer survival rates in Israel, and to Dr Yochai Schonmann for his work on those data. Two of the vignettes were used by kind permission of the ICBP; we also thank Dr Peter Murchie and Dr Rhona Auckland, who generously provided the other two vignettes. Prof. Antonius Schneider kindly organised the Technical University of Munich’s data collection.


  • Delivery of Health Care
  • Primary Health Care
  • Cancer
  • Decision Making
  • Survival
  • Europe
  • international health services
  • adult oncology
  • primary care


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