SynthesisBMJ open2022
Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review.
Synthesis in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The implementation challenge of computerised clinical decision support systems for the detection of disease in primary care: systematic review and recommendations.Implementation science : IS · 2025Pooled it
- The Educational Value of the Missed Opportunity.Journal of cancer education : the official journal of the American Association for Cancer Education · 2026Article
- Diagnostic Delays in Thoracic Cancer Care: A Data-Linkage, Cohort Study between Primary Care, Hospital, and Registry Data.Health data science · 2026Article
- Changes in diagnostic evaluation of patients with lung cancer symptoms.NPJ primary care respiratory medicine · 2025Article
- Adolopment of clinical practice guidelines and creation of referral pathways for dermatological conditions in Pakistan.The Lancet regional health. Southeast Asia · 2025Review
- Interventions to improve timely cancer diagnosis: an integrative review.Diagnosis (Berlin, Germany) · 2025Review
- Decision-Making About Fertility Preservation After Cancer Diagnosis: A Qualitative Study of Patients' Experiences and Perspectives.Cancer management and research · 2025Article
- Understanding GPs' referral decisions for younger patients with symptoms of cancer: a qualitative interview study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Article
- What would primary care practitioners do differently after a delayed cancer diagnosis? Learning lessons from their experiences.Scandinavian journal of primary health care · 2024Article
- Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study.BJGP open · 2023Article
- Predictors of referral behaviour and intention amongst physicians in a medical consortium based on the theory of planned behaviour: a cross-sectional study in China.Frontiers in public health · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
backgroundMissed opportunities for diagnosing cancer cause patients harm and have been attributed to suboptimal use of tests and referral pathways in primary care. Primary care physician (PCP) factors have been suggested to affect decisions to investigate cancer, but their influence is poorly understood.
objectiveTo synthesise evidence evaluating the influence of PCP factors on decisions to investigate symptoms of possible cancer.
methodsWe searched MEDLINE, Embase, Scopus, CINAHL and PsycINFO between January 1990 and March 2021 for relevant citations. Studies examining the effect or perceptions and experiences of PCP factors on use of tests and referrals for symptomatic patients with any cancer were included. PCP factors comprised personal characteristics and attributes of physicians in clinical practice. DATA EXTRACTION AND SYNTHESIS: Critical appraisal and data extraction were undertaken independently by two authors. Due to study heterogeneity, data could not be statistically pooled. We, therefore, performed a narrative synthesis.
results29 studies were included. Most studies were conducted in European countries. A total of 11 PCP factors were identified comprising modifiable and non-modifiable factors. Clinical judgement of symptoms as suspicious or 'alarm' prompted more investigations than non-alarm symptoms. 'Gut feeling' predicted a subsequent cancer diagnosis and was perceived to facilitate decisions to investigate non-specific symptoms as PCP experience increased. Female PCPs investigated cancer more than male PCPs. The effect of PCP age and years of experience on testing and referral decisions was inconclusive.
conclusionsPCP interpretation of symptoms as higher risk facilitated testing and referral decisions for possible cancer. However, in the absence of 'alarm' symptoms or 'gut feeling', PCPs may not investigate cancer. PCPs require strategies for identifying patients with non-alarm and non-specific symptoms who need testing or referral. PROSPERO REGISTRATION NUMBER: CRD420191560515.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.