Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review

Cancer is one of the most commonly missed diagnoses due to lack of testing and referral pathways in general practice. These decisions are affected by primary care physician (PCP) or GP factors such as clinical judgement, gut feeling, and attitude to uncertainty. However, there is limited research around how exactly PCP factors contribute to missed cancer diagnoses. Primary care researchers in the UK, USA, and Australia screened over 4000 studies, 29 of which were included in the final synthesis. The authors identified eleven PCP factors: three comprised demographic factors and eight revolved around clinical reasoning processes, dealing with uncertainty, and professional involvement in continuing medical education. Studies indicated that female GPs further examined possible cancer symptoms compared to male GPs, with higher odds of urgent specialist review and appropriate referral for certain cancers. There was not a clear pattern in terms of age and years of experience as PCP factors. Of all eight modifiable PCP factors, the authors found greater evidence for clinical judgement and gut feeling in contributing to delays in cancer diagnoses. When GPs considered patients’ symptoms to be non-alarm and non-specific, they were less likely to investigate potential cancer diagnoses, leading to diagnostic delay. This was compounded by clinical guidelines that did not account for certain symptoms, leaving GPs to determine the need for referral. In future, clinical guidelines may be modified to include clinical judgement and gut feeling as these factors have been shown to be important in timely diagnoses of cancer. Read the original article here.
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