Auditing the diagnosis of cancer in primary care: the experience in Scotland

Baughan, Paul; O’Neill, Brian; Fletcher, Elaine

doi:10.1038/sj.bjc.6605397

Cited by 56 publications

(65 citation statements)

References 8 publications

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“…A study conducted in Denmark shows that for all cancers combined, the median delay between the onset of the first symptoms and the consultation for medical advice is 3 weeks 6. Based on studies carried out in Scotland and England,8 9 the median delay for patients with head and neck cancers is around 30 days, which appears to be longer than for other tumour locations. More precisely, patients with head and neck cancer show the longest delay among 13 cancers8 and patients with oropharyngeal cancer show the longest delay among 18 cancers 9.…”

Section: Introductionmentioning

confidence: 99%

Determinants of patient delay in doctor consultation in head and neck cancers (Protocol DEREDIA)

et al. 2014

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IntroductionReducing the time between the onset of the first symptoms of cancer and the first consultation with a doctor (patient delay) is essential to improve the vital prognosis and quality of life of patients. Longer patient delay is linked to the already known sociodemographic, socioeconomic, socioeducational, sociocultural and socioprofessional factors. However, recent data suggest that some sociocognitive and emotional determinants may explain patient delay from a complementary point of view. The main objective of this study is to assess whether, in head and neck cancer, patient delay is linked to these sociocognitive and emotional factors, in addition to previously known factors.Methods and analysisWe intend to include in this study 400 patients with a not yet treated head and neck cancer diagnosed in one of six health centres in the North of France region. The main evaluation criterion is ‘patient delay’. Sociocognitive, emotional, medical, sociodemographic, socioeconomic, educational, professional and geographic factors will be assessed by means of (1) a case report form, (2) a questionnaire completed by the clinical research associate together with the patient, (3) a questionnaire completed by the patient and (4) a recorded semidirective interview of the patient by a psychologist (for 80 patients only). The collected data will be analysed to underline the differences between patients who consulted a doctor earlier versus those who consulted later.EthicsThe study has obtained all the relevant authorisations for the protection of patients enrolled in clinical trials (CCTIRS, CCP, CNIL), does not involve products mentioned in article L.5311-1 of the French Code of Public Health, and does not imply any changes in the medical care received by the patients. The study began in October 2012 and will end in June 2015.Trial registrationID-RCB 2012-A00005-38.

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Section: Introductionmentioning

confidence: 99%

Determinants of patient delay in doctor consultation in head and neck cancers (Protocol DEREDIA)

et al. 2014

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“…This follows previous work undertaken within primary care in Scotland where GPs had been asked to audit the referral pathway for all new cancer diagnoses, examining whether the referral had been made urgently (where cancer was suspected), or routinely (where cancer may not have been suspected). 7 …”

Section: Introductionmentioning

confidence: 99%

Urgent suspected cancer referrals from general practice: audit of compliance with guidelines and referral outcomes

Baughan¹,

Keatings²,

O’Neill³

2011

Br J Gen Pract

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An Excel spreadsheet template with defined parameters and preset drop-down options was provided to participating practices, with instructions on its use. The template was locked to prevent changes being made to it. The parameters requested were: age at referral, sex, and specific cancer suspected (bladder, brain, breast, cervical, colorectal, endometrial, gallbladder, laryngeal, leukaemia, liver, lung, lymphoma, melanoma, mesothelioma, myeloma, oesophageal, oropharyngeal, ovarian, pancreatic, prostate, renal, sarcoma, small intestine, stomach, testicular, thyroid, vulval, other AimTo examine primary care referral patterns, compliance with referral guidance, and eventual outcome for patients. Design and settingProspective audit within general practice in Scotland. MethodGPs in Scotland reviewed all urgent suspected cancer referrals over a 6-month period. They noted the final diagnosis and assessed whether the referral was in accordance with agreed referral guidelines. ResultsA total of 18 775 urgent suspected cancer referrals were analysed from 516 GP practices. The referral rate ranged from 3.7 to 24.0 per 1000 per annum; 30.8% of referrals were for patients aged under 50 years, yet this age group accounts for only 11.1% of all diagnosed cancers; 10.3% of all urgent cancer referrals were for suspected melanoma, despite this cancer accounting for only 4.1% of new cancers. The proportion of patients subsequently diagnosed with cancer was greatest for leukaemia (61.7%), prostate (52.6%), and lung cancer referrals (39.7%), and lowest for melanoma (11.8%), oesophago-gastric (11.2%), brain (10.6%), and laryngeal cancer referrals (7.8%). Compliance with referral guidelines was 90.9%. A large proportion of referrals considered to be outside the guidelines still had a cancer diagnosed (urological 15.9%, lung 8.8%, colorectal 8.4%, and breast 6.4%). ConclusionThere is wide variation in GP referral rates for suspected cancer with a greater than expected proportion of referrals for younger people. Many referrals considered to be outside the national guidelines were diagnosed with cancer, suggesting factors other than those in referral guidelines alert GPs to the possibility of cancer.

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“…12 This risk is particularly concerning for melanoma compared with other cancers as the majority are detected by the patient rather than their clinician, and the time taken to present to a clinician from first noticing a skin change or symptom is longer than for all other cancers except those of the head and neck. 13 In this paper we report a review of currently available smartphone apps for the detection of melanoma aimed at general community, patient or generalist clinician users, evaluating their content and the evidence applied in their development.…”

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confidence: 99%

Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review

et al. 2015

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Smartphone health applications ('apps') are widely available but experts remain cautious about their utility and safety. We reviewed currently available apps for the detection of melanoma (July 2014), aimed at general community, patient and gen-eralist clinician users. A proforma was used to extract and assess each app that met the inclusion criteria, and we undertook content analysis to evaluate their content and the evidence applied in their development. Thirty-nine apps were identified with the majority available only for Apple users. Over half (n = 22) provided information or education about melanoma, ultraviolet radiation exposure prevention advice, and skin self-examination strategies, mainly using the ABCDE (A, Asymmetry ; B, Border; C, Colour; D, Diameter; E, Evolving) method. Half (n = 19) helped users take and store images of their skin lesions either for review by a dermatologist or for self-monitoring to identify change, an important predictor of melanoma; a similar number (n = 18) used reminders to help users monitor their skin lesions. A few (n = 9) offered expert review of images. Four apps provided a risk assessment to patients about the probability that a lesion was malignant or benign, and one app calculated users' future risk of melanoma. None of the apps appeared to have been validated for diagnostic accuracy or utility using established research methods. Smartphone apps for detecting melanoma by nonspecialist users have a range of functions including information, education, classification, risk assessment and monitoring change. Despite their potential usefulness, and while clinicians may choose to use apps that provide information to educate their patients, apps for melanoma detection require further validation of their utility and safety. What's already known about this topic? • Earlier detection of melanoma would allow timely treatment and could improve outcomes. • Although smartphone applications ('apps') are recognized as having potentially wide use in dermatology and oncology, experts have expressed caution concerning their diagnostic utility and safety. What does this study add? • We identified almost 40 smartphone apps available to detect or prevent melanoma by nonspecialist users including previously unaffected individuals, patients previously diagnosed with skin cancer, and generalist clinicians. • Most apps gave advice or education about melanoma, ultraviolet radiation exposure preventive advice, and skin self-examination strategies; half of the apps enabled patients to capture and store images of their skin lesions either for review by a dermatologist or for self-monitoring to identify change, an important predictor of melanoma; only four apps provided a risk assessment about a skin lesion.

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Auditing the diagnosis of cancer in primary care: the experience in Scotland

Cited by 56 publications

References 8 publications

Determinants of patient delay in doctor consultation in head and neck cancers (Protocol DEREDIA)

Determinants of patient delay in doctor consultation in head and neck cancers (Protocol DEREDIA)

Urgent suspected cancer referrals from general practice: audit of compliance with guidelines and referral outcomes

Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review

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