Development of a survey instrument to investigate the primary care factors related to differences in cancer diagnosis between international jurisdictions

Abstract

BackgroundSurvival rates following a diagnosis of cancer vary between countries. The International Cancer Benchmarking Partnership (ICBP), a collaboration between six countries with primary care led health services, was set up in 2009 to investigate the causes of these differences. Module 3 of this collaboration hypothesised that an association exists between the readiness of primary care physicians (PCP) to investigate for cancer – the ‘threshold’ risk level at which they investigate or refer to a specialist for consideration of possible cancer – and survival for that cancer (lung, colorectal and ovarian). We describe the development of an international survey instrument to test this hypothesis.MethodsThe work was led by an academic steering group in England. They agreed that an online survey was the most pragmatic way of identifying differences between the jurisdictions. Research questions were identified through clinical experience and expert knowledge of the relevant literature.A survey comprising a set of direct questions and five clinical scenarios was developed to investigate the hypothesis. The survey content was discussed and refined concurrently and repeatedly with international partners. The survey was validated using an iterative process in England. Following validation the survey was adapted to be relevant to the health systems operating in other jurisdictions and translated into Danish, Norwegian and Swedish, and into Canadian and Australian English.ResultsThis work has produced a survey with face, content and cross cultural validity that will be circulated in all six countries. It could also form a benchmark for similar surveys in countries with similar health care systems.ConclusionsThe vignettes could also be used as educational resources. This study is likely to impact on healthcare policy and practice in participating countries.

International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data

“…15 Each vignette described a patient presenting to primary care and the sequential presentation of cancer-related symptoms in up to three stages. Primary care practitioners were asked to choose which action they would take at each stage.…”

“…A definitive action was defined as any secondary care referral or a test undertaken in primary care with a high probability of diagnosing underlying cancer. 15 Definitive tests were:…”

“…Adherence was only measured for stage one of each vignette (details available from the authors on request) as definitive action ended the vignette for that responder; consequently there was a significant attrition in the number of responders after stage one. 15 Analysis. To identify factors that may contribute to the relatively low survival rates observed in the UK, pooled estimates for adherence and definitive action were compared for UK jurisdictions and their non-UK counterparts.…”

“…Data from a recent, large validated international survey of primary care practitioners developed by primary care cancer experts were used. 15 The main limitations of this analysis are:…”

“…Module three of the partnership (ICBP3) focuses on primary care and conducted a survey investigating systems and practice around the management of symptoms of cancer. 15 It included multistage vignettes involving patients presenting with symptoms suggestive of cancer. The full results are published elsewhere; a positive correlation was found in each jurisdiction between the primary care practitioner's willingness to act definitively at an earlier stage of the scenarios and 1-year (and conditional 5-year) survival rates.…”