How do general practitioners manage patients with cancer symptoms? A video-vignette study

Moyez Jiwa, Xingqiong Meng, Carolyn O'Shea, Parker Magin, Ann Dadich, Vinita Pillai

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    Abstract

    Objectives: Determine how general practitioners (GPs) manage patients with cancer symptoms. Design: GPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to available guidelines, all cases warranted a referral to a specialist or further investigations. Setting: Australian primary care sector. Participants: 102 practising GPs participated in this study, including trainees. Interventions: The research was part of a larger randomised controlled trial testing a referral pro forma; however, this paper reports on management decisions made throughout the study. Primary and secondary outcome measures: This paper reports on how the participants would manage the patients depicted in each vignette. Results: In more than one-in-eight cases, the patient was not investigated or referred. Patient management varied significantly by cancer type (p<0.001). For two key reasons, colorectal cancer was the chosen referent category. First, it represents a prevalent type of cancer. Second, in this study, colorectal cancer symptoms were managed in a similar proportion of options-that is, prescription, referral or investigation. Compared with vignettes featuring colorectal cancer participants were less likely to manage breast, bladder, endometrial, and lung cancers with a 'prescription only' or 'referral only' option. They were less likely to manage prostate cancer with a 'prescription only', yet more likely to manage it with a 'referral with investigation'. With regard to pancreatic and cervical cancers, participants were more likely to manage these with a 'referral only' or a 'referral with investigation'. Conclusions: Some patients may receive a delayed cancer diagnosis, even when they present with typical cancer symptoms to a GP who can access relevant diagnostic tests.

    Original languageEnglish
    Article numbere008525
    Pages (from-to)e008525
    Number of pages8
    JournalBMJ Open
    Volume5
    Issue number9
    DOIs
    Publication statusPublished - 2015

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  • Cite this

    Jiwa, M., Meng, X., O'Shea, C., Magin, P., Dadich, A., & Pillai, V. (2015). How do general practitioners manage patients with cancer symptoms? A video-vignette study. BMJ Open, 5(9), e008525. [e008525]. https://doi.org/10.1136/bmjopen-2015-008525