Interventions to reduce primary care delay in cancer referral: a systematic review

Mansell, Gemma; Shapley, Mark; Jordan, Joanne L.; Jordan, Kelvin

doi:10.3399/bjgp11x613160

Cited by 47 publications

(55 citation statements)

References 29 publications

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“…Interventions in pharmacy services reduced suboptimal prescribing [117, 127, 133], and educational interventions improved primary healthcare providers’ identification, assessment, prevention and/or management of obesity in children and adolescents to achieve weight loss [121]. No review focused exclusively on audit and feedback, but multifaceted audit/feedback, reminders, educational outreach visits, and patient-mediated interventions [31, 116, 118, 119] were found to be effective in influencing health professionals’ prescribing practice. Financial incentives combined with educational interventions and audit/feedback have been found to be effective in increasing the practice of generic prescribing [124].…”

Section: Resultsmentioning

confidence: 99%

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

et al. 2017

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BackgroundThere is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers.MethodsStudy design: overview of reviews.Data source: MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015).Study selection: two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language.Data extraction and synthesis: two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors’ conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.).ResultsOf 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change.ConclusionsBehavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0538-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

et al. 2017

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“…This evaluation was preceded by an evaluation of the desk-based RATs (Hamilton et al, 2013;Green et al, 2014) and has reiterated several of the findings from that study, but has given new insights into the challenges and opportunities of transferring desk-or paper-based guidance to an electronic system -even at a time when electronic tools are the common currency of society. In their systematic review, Mansell et al (2011) found limited evidence to suggest that complex interventions have addressed primary-care aspects of cancer recognition and referral to date, but concluded that those that offer improvements to practitioners' knowledge of cancer symptoms might lead to changes in behaviour, which in turn impacts attitudes and decision-making. Appropriately supported dissemination of clinical decisionsupport tools for cancer may well have a role in this endeavour.…”

Section: Discussionmentioning

confidence: 99%

“…There is agreement that cancer diagnosis in primary care is complex and attempts have been made to understand (Hamilton, 2009), and impact upon this process (Mansell et al, 2011). Research has been carried out to comprehend in greater detail the symptoms that cancer patients present within primary care, and from these analyses to develop algorithms to assist GPs in assessing patients with potential cancer symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…In the UK healthcare system, this pathway involves primary care, and most commonly general practitioners (GPs). Owing to their traditional gate-keeping role within the UK healthcare system, there is an emerging body of work on the role of GPs in the process to cancer diagnosis (Richards, 2009;Hippisley-Cox and Coupland, 2011;Mansell et al, 2011;Hamilton et al, 2013;Mitchell et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Embedding electronic decision-support tools for suspected cancer in primary care: a qualitative study of GPs’ experiences

Dikomitis

Green

Macleod

2015

Prim Health Care Res Dev

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Aim: The purpose of this evaluation was to obtain views from general practitioners (GPs) who piloted the electronic risk assessment tools (eRATs) for suspected lung or colorectal cancer. We wanted to find out whether GPs were able to integrate these tools into their everyday practice. We were also keen to identify facilitators and barriers to their more widespread use. Background: Cancer remains one of UK's biggest health problems, in terms of morbidity and mortality. Comparative European data show that five-year survival figures for many cancers are lower in the United Kingdom than in comparable European countries. eRATs are intended to aid recognition of symptoms of lung and colorectal cancers in patients aged 40 years and over. Methods: This was a qualitative study; telephone interviews were conducted with 23 GPs who piloted the eRATs. A systematic qualitative analysis was applied to the data. The normalisation process model was used after data collection. This theory-driven conceptual framework was used to examine the operationalisation of this intervention in Primary Care. Findings: Electronic decision-support tools appear to be useful additions to the resources available to GPs in order to assist them with recognizing potential cancer symptoms. However, the tools need to be refined in order to integrate them into GP practice. The tools raised GPs' awareness about cancer because of the prompt facility of the software, although this also raised the potential of 'prompt fatigue'. GPs constantly receive alerts via their clinical system, particularly related to the Quality and Outcomes Framework. The integration of eRATs into routine practice could be engendered by improvement to the training packages that accompany them, and by its delivery via a platform compatible with all GP clinical systems.

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“…These have been evaluated as risk assessment tools (RATs) in paper versions25 and are currently undergoing evaluation as computerised decision support tools embedded in the electronic medical records of English general practices 26. Various interventions including audit and feedback, educational visits, guidelines and decision support have been tested in general practice to improve cancer diagnosis 27. None of the 22 trials included in a systematic review of interventions to support cancer diagnosis in primary care examined effects on diagnostic delay, although audit and feedback was shown to improve clinical management 28…”

Section: Introductionmentioning

confidence: 99%

The Improving Rural Cancer Outcomes (IRCO) Trial: a factorial cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural patients with cancer in Western Australia: a study protocol

et al. 2014

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IntroductionWhile overall survival for most common cancers in Australia is improving, the rural–urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA).Methods and analysisThe community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness.Ethics and disseminationEthics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA.ResultsResults of this trial will be reported in peer-reviewed publications and in conference presentations.Trial registration numberAustralian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12610000872033.

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Interventions to reduce primary care delay in cancer referral: a systematic review

Cited by 47 publications

References 29 publications

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

Embedding electronic decision-support tools for suspected cancer in primary care: a qualitative study of GPs’ experiences

The Improving Rural Cancer Outcomes (IRCO) Trial: a factorial cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural patients with cancer in Western Australia: a study protocol

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