General practitioners’ anticipated risk of cancer at referral and their attitude to risk taking and to their role as gatekeeper

Pedersen, Anette Fischer; Vedsted, Peter

doi:10.1177/1355819615601822

Cited by 6 publications

(20 citation statements)

References 20 publications

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“… 42 PCPs 60 years and above tended to estimate cancer risk at referral to be higher than PCPs younger than 45 years, though this finding was non-significant. 45 There was also no difference in mean age at referral between PCPs using and not using direct CT referral for lung cancer. 61 …”

Section: Resultsmentioning

confidence: 88%

“…There was also no observable trend between PCP sex and use of investigations for lung cancer, 23 48 nor was there an association with estimation of cancer risk at urgent referral. 45 …”

Section: Resultsmentioning

confidence: 99%

“… 40 Findings from a Danish vignette survey suggested that PCPs overestimate cancer risk as approximately one-third of PCPs' anticipated cancer risk at referral for a hypothetical patient to exceed 50%. 45 …”

Section: Resultsmentioning

confidence: 99%

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Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review

et al. 2022

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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 synthesisCritical 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 numberCRD420191560515.

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Section: Resultsmentioning

confidence: 88%

“…There was also no observable trend between PCP sex and use of investigations for lung cancer, 23 48 nor was there an association with estimation of cancer risk at urgent referral. 45 …”

Section: Resultsmentioning

confidence: 99%

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Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review

et al. 2022

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“…General practitioners (GPs) are medical professionals affiliated with primary medical service institutions who provide primary care and health management services [1,2]. GPs mainly respond to common diseases and general emergencies [3]. GPs often efficiently provide care, quickly treat ailments, and somewhat justify referrals and hospitalizations for difficult cases [4].…”

Section: Introductionmentioning

confidence: 99%

The global prevalence of turnover intention among general practitioners: a systematic review and meta-analysis

Shen

Jiang

et al. 2020

BMC Fam Pract

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Background General practitioners (GPs) are the foundation of any primary healthcare system. Their quality and quantity are directly associated with the effectiveness and quality of the health services of a nation. GPs’ shortage and turnover have become an important issue in developed and developing countries. An accurate estimate of turnover intention prevalence among GPs would have important health policy implications, but the overall prevalence is unknown. We aimed to summarize the global prevalence of turnover intention and associated factors among GPs. Methods We systematically reviewed the PubMed, Embase, Web of Science and China National Knowledge Infrastructure (CNKI) databases from their inception up to May 2020, as well as the reference lists of all included studies. We included observational studies that reported data on turnover intention or their prevalence rate among GPs could be calculated based on the information provided. The prevalence rate of the turnover intentions was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I2 statistic. Differences by study level characteristics were estimated via subgroup analysis and meta-regression. Results A total of 25 cross-sectional studies were included (a total of 27,285 participants). The prevalence of turnover intention was 0.47 (95% CI: 0.39–0.55). Those having a lower level of salary (OR = 1.38, 95% CI: 1.13–1.63) and job satisfaction (OR = 1.35, 95% CI: 1.12–1.70) or having lower level of morale (OR = 2.68, 95% CI: 1.56–3.80) had a higher intention. In contrast, GPs with a lower level of professional title had a lower turnover intention (OR = 0.81, 95% CI: 0.65–0.98). Conclusions In this systematic review, approximately half of the GPs had the intention to leave their current posts worldwide. The factors associated with turnover intention were higher professional title, lower income level, lower job satisfaction and lower morale.

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“… 10 This result is contradictory with studies showing that some GPs may be, in practice, take too many risks on behalf of the patients which can lead to detrimental consequences for the patients [ 45 , 46 ]. …”

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confidence: 99%

Comparing GPs’ risk attitudes for their own health and for their patients’ : a troubling discrepancy?

Nebout

Cavillon²,

Ventelou

2018

BMC Health Serv Res

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BackgroundIn this paper, we report the results of risk attitudes elicitation of a French general practitioners national representative sample (N=1568).MethodsWillingness to take risks in four different domains (daily life, financial matters, own health and patient health) was collected through a large-scale telephone interview of GPs using self-reported 11-point Likert scale questions.ResultsWe uncover some specificities of the GPs population regarding their attitudes towards risk. In particular, we detect an important positive gap between their willingness to take risks in the domain of their own health and in the domain of the heath of their patients. This “patient-regarding” risk aversion is discussed with respect to its important consequences regarding medical behavior bias.ConclusionsWe confirm the self-other discrepancy found in the medical literature on physicians’ behaviors and emphasize the utility of the study and measures of personality traits such as “risk attitudes” for the medical professions and for the population they address.

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General practitioners’ anticipated risk of cancer at referral and their attitude to risk taking and to their role as gatekeeper

Abstract: General practitioners either overestimate the risk of cancer when referring for suspected cancer or they appear to need to be very sure of the cancer diagnosis before referral. Further, focus on tolerance for ambiguity should be included in the education of general practitioners.

Cited by 6 publications

References 20 publications

Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review

Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review

The global prevalence of turnover intention among general practitioners: a systematic review and meta-analysis

Comparing GPs’ risk attitudes for their own health and for their patients’ : a troubling discrepancy?

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