Mitchinson, Lucy;
Von Wagner, Christian;
Blyth, Alexandra;
Shah, Heer;
Rafiq, Meena;
Merriel, Samuel William David;
Barclay, Matthew;
... Renzi, Cristina; + view all
(2024)
Clinical decision-making on lung cancer investigations in primary care: a vignette study.
BMJ Open
, 14
(8)
, Article e082495. 10.1136/bmjopen-2023-082495.
Preview |
Text
Renzi_e082495.full.pdf Download (583kB) | Preview |
Abstract
Objectives: To investigate the role of comorbid chronic obstructive pulmonary disease (COPD) and symptom type on general practitioners’ (GP’s) symptom attribution and clinical decision-making in relation to lung cancer diagnosis. // Design: Vignette survey with a 2×2 mixed factorial design. // Setting: A nationwide online survey exploring clinical decision-making in primary care. // Participants: 109 GPs based in the United Kingdom (UK) who were registered as responders on Dynata (an online survey platform). // Interventions: GPs were presented with four vignettes which described a patient aged 75 with a smoking history presenting with worsening symptoms (either general or respiratory) and with or without a pre-existing diagnosis of COPD. // Primary and secondary outcome measures: GPs indicated the three most likely diagnoses (free-text) and selected four management approaches (20 pre-coded options). Attribution of symptoms to lung cancer and referral for urgent chest X-ray were primary outcomes. Alternative diagnoses and management approaches were explored as secondary outcomes. Multivariable mixed-effects logistic regression was used, including random intercepts for individual GPs. // Results: 422 vignettes were completed. There was no evidence for COPD status as a predictor of lung cancer attribution (OR=1.1, 95% CI=0.5–2.4, p=0.914). There was no evidence for COPD status as a predictor of urgent chest X-ray referral (OR=0.6, 95% CI=0.3–1.2, p=0.12) or as a predictor when in combination with symptom type (OR=0.9, 95% CI=0.5–1.8, p=0.767). // Conclusions: Lung cancer was identified as a possible diagnosis for persistent respiratory by only one out of five GPs, irrespective of the patients’ COPD status. Increasing awareness among GPs of the link between COPD and lung cancer may increase the propensity for performing chest X-rays and referral for diagnostic testing for symptomatic patients.
| Type: | Article |
|---|---|
| Title: | Clinical decision-making on lung cancer investigations in primary care: a vignette study |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1136/bmjopen-2023-082495 |
| Publisher version: | http://dx.doi.org/10.1136/bmjopen-2023-082495 |
| Language: | English |
| Additional information: | Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10196256 |
Archive Staff Only
 |
View Item |
