Aids to cancer diagnosis in primary care

Introduction

General practitioners may find it helpful to refer to cancer decision-support tools when deciding if their patient should be sent for cancer testing. If we are to understand fully the clinical- and cost-effectiveness of these tools, we first need to find out how widely available the tools are, and how likely they are to be used.

We carried out a cross-sectional, postal survey of general practitioners in the UK, to answer our research questions:

• What proportion of general practices in the UK has access to cancer decision-support tools?
• For those general practices with access to tools, what proportion is likely to use them?
• Is there an association between a practice’s access to cancer decision-support tools and their suspected-cancer referral activity?

Aims & objectives

The project’s main aims were to quantify:

• The proportion of general practices in the UK with access to cancer decision-support tools
• The proportion of practices that have access to, and use, the tools

The secondary aim was to investigate for an association between a practice’s access to cancer tools and their referral activity for suspected cancer.

Methodology

We invited 4,600 general practitioners from a random sample of 975 UK general practices to complete our survey. To answer our main research questions (above), our outcome measures included the proportions of UK general practices where cancer decision-support tools are available, and at least one general practitioner uses the tool.

We used weighted least-squares linear regression with robust errors to test for an association between cancer decision-support tool availability and the number of two-week-wait referrals made by the practice. These analyses adjusted for the practice profile in terms of size, sex, age and index of multiple deprivation. All practice-level data were obtained from Public Health profiles published by Public Health England (https://fingertips.phe.org.uk/).

Outputs & impact

We received responses from 476 GPs in 227 practices. Cancer decision-support tools were available in 83/227 (36.6%, 95% confidence interval 30.3% to 43.1%) practices. Tools were available and likely to be used in 38/227 (16.7%, 12.1% to 22.2%) practices. In sub-group analyses of 172 English practices, there was no difference in mean two-week-wait referral rate between practices with tools and those without (mean adjusted difference in referrals per 100,000: 3.1, -5.5 to +11.7). Our study concluded that the tools were currently an underused resource available to help general practitioners in making suitable referrals for cancer testing.

Next steps

Running alongside this survey, the HTA project is also carrying out:

• A systematic review to summarise the clinical- and cost-effectiveness of symptom-based diagnostic tools that could be used to inform decision-making in primary care
• A systematic review to identify studies reporting the development, validation or accuracy of diagnostic prediction models that have the potential to be developed into a cancer decision-support tool
• Decision analytic modelling to explore uncertainties in the cost-effectiveness of using cancer decision-support tools, including impacts on health device resource use, costs and patient outcomes in colorectal cancer

Related projects

The ERICA Trial – a randomised controlled trial to assess the clinical and cost-effectiveness of electronic Risk Assessment Tools (eRATs) for cancer compared to usual care for patients in general practice. The specific objectives of this study are to compare the effects of eRATs (vs usual care) on cancer staging at time of diagnosis, cost to the NHS, patient experience of care and service delivery.