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?
- Project Lead: Dr Sarah Price (University of Exeter)
- Senior CanTest Lead: Prof Willie Hamilton
- Others involved: Prof Anne Spencer, Prof Richard Neal
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 & activity
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.
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 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
As the level of uptake of the cancer decision-support tools is low, it is possible to carry out a randomised controlled trial to investigate their clinical- and cost-effectiveness (see The ERICA trial, which is now underway).
Price, S., Spencer, A., Medina-Lara, A., Hamilton, W. on behalf of the Exeter/Bangor/Leeds Cancer Diagnostic Support in Primary Care HTA Group (2019) Availability of cancer decision-support tools: A cross-sectional survey of UK primary care. Br J Gen Pract (in press)