2022
DOI: 10.1136/bmjopen-2021-053732
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Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review

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 19… Show more

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Cited by 6 publications
(5 citation statements)
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“…The findings add to earlier work demonstrating that, although GPs consider the guidelines helpful overall, especially for patients with clear-cut symptoms, they may act as a barrier for patients not fitting the criteria, because of the perceived lack of flexibility and limited scope for clinical judgement. 13 15 Although the role of ‘gut feeling’ in driving GPs’ decisions has been examined previously, 16 , 17 the findings of this study extend the literature on its crucial influence on referral of younger patients. GPs described a struggle in reconciling their dual role as patient advocate and gatekeeper of resources, and the deep sense of worry of potentially missing a cancer diagnosis, which often led them to a cautionary approach.…”
Section: Discussionsupporting
confidence: 63%
“…The findings add to earlier work demonstrating that, although GPs consider the guidelines helpful overall, especially for patients with clear-cut symptoms, they may act as a barrier for patients not fitting the criteria, because of the perceived lack of flexibility and limited scope for clinical judgement. 13 15 Although the role of ‘gut feeling’ in driving GPs’ decisions has been examined previously, 16 , 17 the findings of this study extend the literature on its crucial influence on referral of younger patients. GPs described a struggle in reconciling their dual role as patient advocate and gatekeeper of resources, and the deep sense of worry of potentially missing a cancer diagnosis, which often led them to a cautionary approach.…”
Section: Discussionsupporting
confidence: 63%
“… 26 The present study's responders’ reports of inadequate plans for follow-up, as well as reassurance from normal test results, have also been reported by other researchers. 8 , 30 , 31 …”
Section: Discussionmentioning
confidence: 99%
“…Some PCPs in our study regretted not having acted on their sense of alarm, and doing so might have helped to trigger investigations for cancer [ 20 ]. This is supported by a Nordic study, in which some doctors recognised that intuitive feelings of alarm helped them to come to think of cancer during a clinical encounter [ 21 ].…”
Section: Discussionmentioning
confidence: 99%