دورية أكاديمية
أعرض في EDS

Clinical decision-making on lung cancer investigations in primary care: a vignette study.

التفاصيل البيبلوغرافية
العنوان: Clinical decision-making on lung cancer investigations in primary care: a vignette study.
المؤلفون: Mitchinson L; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK., von Wagner C; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK c.wagner@ucl.ac.uk., Blyth A; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK., Shah H; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK., Rafiq M; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.; Department of Primary Care, University of Melbourne, Melbourne, Victoria, Australia., Merriel SWD; Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, UK., Barclay M; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK., Lyratzopoulos G; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK., Hamilton W; College of Medicine and Health, University of Exeter Medical School, Exeter, UK., Abel GA; College of Medicine and Health, University of Exeter Medical School, Exeter, UK., Renzi C; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.; Faculty of Medicine, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy.
المصدر: BMJ open [BMJ Open] 2024 Aug 21; Vol. 14 (8), pp. e082495. Date of Electronic Publication: 2024 Aug 21.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
مواضيع طبية MeSH: Lung Neoplasms*/diagnosis , Pulmonary Disease, Chronic Obstructive*/diagnosis , Primary Health Care* , Clinical Decision-Making* , General Practitioners*, Humans ; Male ; Female ; United Kingdom ; Aged ; Middle Aged ; Referral and Consultation/statistics & numerical data ; Practice Patterns, Physicians'/statistics & numerical data ; Surveys and Questionnaires ; Adult ; Logistic Models
مستخلص: 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.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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فهرسة مساهمة: Keywords: adult oncology; chronic airways disease; clinical decision-making; lung diseases; primary care
تواريخ الأحداث: Date Created: 20240822 Date Completed: 20240822 Latest Revision: 20240824
رمز التحديث: 20240826
مُعرف محوري في PubMed: PMC11340710
DOI: 10.1136/bmjopen-2023-082495
PMID: 39174063
قاعدة البيانات: MEDLINE
الوصف
تدمد:2044-6055
DOI:10.1136/bmjopen-2023-082495