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Multicenter Study
. 2015 May 27;5(5):e007212.
doi: 10.1136/bmjopen-2014-007212.

Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey

Peter W Rose  1 , Greg Rubin  2 , Rafael Perera-Salazar  1 , Sigrun Saur Almberg  3 , Andriana Barisic  4 , Martin Dawes  5 , Eva Grunfeld  6 , Nigel Hart  7 , Richard D Neal  8 , Marie Pirotta  9 , Jeffrey Sisler  10 , Gerald Konrad  11 , Berit Skjødeberg Toftegaard  12 , Hans Thulesius  13 , Peter Vedsted  14 , Jane Young  15 , Willie Hamilton  16 ; ICBP Module 3 Working Group*; ICBP Module 3 Working Group
Collaborators, Affiliations
Multicenter Study

Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey

Peter W Rose et al. BMJ Open. .

Abstract

Objectives: The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences.

Design: A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer.

Participants: 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.

Primary and secondary outcome measures: Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate.

Results: 4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables.

Conclusions: We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer-either directly, or by specialist referral, to improve outcomes.

Keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT; ONCOLOGY.

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Figures

Figure 1
Figure 1
Scatterplots of vignettes and multiple regression analysis (PCP, primary care physicians).
Figure 1
Figure 1
Scatterplots of vignettes and multiple regression analysis (PCP, primary care physicians).
Figure 1
Figure 1
Scatterplots of vignettes and multiple regression analysis (PCP, primary care physicians).
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References

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