Primary care practitioners' diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries

Research output: Contribution to journalArticle


OBJECTIVES: Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners' (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs' diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries. DESIGN: A primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated. SETTING: Centres in 20 European countries with widely varying cancer survival rates. PARTICIPANTS: A total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country. RESULTS: PCPs' likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers. CONCLUSION: When given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.


  • Michael Harris
  • Mette Brekke
  • Geert Jan Dinant
  • Magdalena Esteva
  • Robert Hoffman
  • Mercè Marzo-Castillejo
  • Peter Murchie
  • Ana Luísa Neves
  • Emmanouil Smyrnakis
  • Peter Vedsted
  • Isabelle Aubin-Auger
  • Joseph Azuri
  • Krzysztof Buczkowski
  • Nicola Buono
  • Gergana Foreva
  • Svjetlana Gašparović Babić
  • Eva Jacob
  • Tuomas Koskela
  • Davorina Petek
  • Marija Petek Šter
  • Aida Puia
  • Jolanta Sawicka-Powierza
  • Sven Streit
  • Birgitta Weltermann
  • Gordon Taylor
External organisations
  • University of Bath
  • University of Bern
  • University of Oslo
  • Maastricht University
  • Tel-Aviv University
  • Institut Universitari d’Investigació en Atenció Primària Jordi Gol
  • University of Aberdeen
  • Imperial College London
  • University of Porto
  • Aristotle University of Thessaloniki
  • Aarhus University
  • Paris Diderot University
  • Nicolaus Copernicus University
  • Croatian Health Insurance Fund
  • University of Tampere
  • University of Ljubljana
  • University of Medicine and Pharmacy, Cluj-Napoca
  • Medical University of Bialystok
  • University of Bonn
  • University of Exeter
  • Instituto de Investigación sanitaria Illes Balears (idISBA)
  • National Society of Medical Education in General Practice (SNAMID)
  • Medical Center Brod, Plovdiv
  • Centro de Saúde de Sarria
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Public Health, Global Health, Social Medicine and Epidemiology


  • adult oncology, international health services, primary care
Original languageEnglish
Pages (from-to)e035678
JournalBMJ Open
Issue number10
Publication statusPublished - 2020 Oct 31
Publication categoryResearch