General practitioners’ clinical decision-making in patients that could have cancer: a vignette study comparing the Baltic states with four Nordic countries

Relative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics. A survey of GPs using clinical vignettes. General Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden. General Practitioners. A regional comparison of GPs’ stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%). Of the 427 GPs that completed the questionnaire, those in the Baltic states, and GPs that were more experienced, were more likely to arrange a key diagnostic test and/or refer their patient to a specialist than those in Nordic Countries or who were less experienced (p While relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs’ reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences.

波罗的海国家的1年相对癌症生存率低于欧洲平均水平，北欧国家则高于该平均水平。本研究针对上述两个区域，调查了全科医师（General Practitioners）对癌症低但显著风险患者进行排查或转诊的可能性，以及全科医师的人口统计学特征对该诊疗行为的影响。本研究采用临床情景案例开展全科医师问卷调查，调研覆盖丹麦、爱沙尼亚、芬兰、拉脱维亚、立陶宛、挪威及瑞典七个国家，研究对象为全科医师。本研究的核心比较内容为：针对癌症风险处于1.2%至3.6%的低但显著风险的患者，两个区域全科医师明确提出的即时诊断举措——即是否开展关键诊断检测及/或转诊至专科医师。在完成问卷的427名全科医师中，波罗的海国家的全科医师以及从业经验更丰富的全科医师，相较于北欧国家的全科医师或从业经验较浅的全科医师，更有可能安排关键诊断检测及/或将患者转诊至专科医师。尽管波罗的海国家的1年相对癌症生存率低于北欧四国，但本研究未发现证据表明这一差异源于当地全科医师不愿采取即时诊断措施——事实上波罗的海国家的全科医师在首次问诊时更倾向于开展排查及/或转诊。未来仍需针对患者及二级诊疗机构相关因素开展研究，以解释癌症生存率的区域差异。