ArticleBMJ open2018
Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion: a European cross-sectional survey.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Referral patterns to a Middle Eastern oral medicine service: a retrospective analysis.BMC health services research · 2026Article
- Causes of diagnostic and treatment delays in locally advanced breast cancer: a nationwide multicenter survey and electronic health records analysis in Turkiye.European journal of public health · 2025Article
- Factors influencing referral among women attending post abortion care at tertiary hospitals in Northern Uganda.Scientific reports · 2025Article
- Advanced Stage Head and Neck Cancer Diagnosis: HEADSpAcE Consortium Health Systems Benchmarking Survey.Head & neck · 2025Article
- General practitioners' clinical decision-making in patients that could have cancer: a vignette study comparing the Baltic states with four Nordic countries.Scandinavian journal of primary health care · 2025Article
- Hidden systems in primary care cancer detection: an embedded qualitative intervention development study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Article
- Referral challenges for early-onset colorectal cancer: a qualitative study in UK primary care.BJGP open · 2023Article
- Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study.BJGP open · 2023Article
- Primary care practitioners' priorities for improving the timeliness of cancer diagnosis in primary care: a European cluster-based analysis.BMC health services research · 2023Article
- Women's experiences along the ovarian cancer diagnostic pathway in Catalonia: A qualitative study.Health expectations : an international journal of public participation in health care and health policy · 2023Article
- Protocol for Establishing a Stakeholder Group for Primary Care Research into Cancer Using a Modified 7P Framework and an e-Delphi Process.HRB open research · 2023Article
- Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective.Scandinavian journal of primary health care · 2021Article
- Primary care practitioners' diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries.BMJ open · 2020Article
- Patient's travel distance to specialised cancer diagnostics and the association with the general practitioner's diagnostic strategy and satisfaction with the access to diagnostic procedures: an observational study in Denmark.BMC family practice · 2020Observational
- Economic burden of vertigo: a systematic review.Health economics review · 2019Review
- Primary care physicians' access to in-house ultrasound examinations across Europe: a questionnaire study.BMJ open · 2019Article
- How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis.BMJ open · 2019Article
Corrections and comments
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Authors and funding
27 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesCancer 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.
designBased 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.
settingA primary care study; 25 participating centres in 20 European countries.
participants1830 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.
resultsFactor 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.
conclusionsFive 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.
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