Referring advanced cancer patients for palliative treatment: a national structured vignette survey of Australian GPs.
Source
Faculty of Health Sciences and.
Abstract
BACKGROUND:
Although
(general practitioners) GPs have a role in managing patients with
advanced cancer, little is known about their referral decisions.Aim.The
aim of this study was to explore, using structured vignettes, how GPs
might manage patients presenting with advanced cancer.
DESIGN:
A
self-administered survey consisting of structured vignettes was
administered to GPs in Australia. Fifty-six vignettes describing
patients who may benefit from palliative
care and/or treatment were constructed encompassing seven advanced
cancer diagnoses (cerebral metastasis, lung metastases, renal cancer,
bone metastases, ulcerating skin metastases, spinal metastases and
stridor) and three clinical variables (age, prognosis and mobility).
Seven vignettes were presented to each respondent. Respondents were
asked if they would refer the patient and the benefits of different
treatment modalities. Participant responses were compared with responses
provided by an expert panel. Logistic regression and parametric tests
were used to estimate odds of referral.Setting/Participants.The
respondents were GPs, currently registered and practicing in Australia.
Participants were selected randomly from a national list of
practitioners.
RESULTS:
Four hundred and seven
questionnaires were received. There was wide variation (31%-97%) in the
proportion of respondents who agreed with the expert panel. The odds of
referral for radiotherapy varied the most. Significant predictive variables included patient age, mobility and prognosis and respondent demographics.
CONCLUSION:
GPs'
referral decisions for patients with advanced cancer appear to deviate
from expert opinion and can be predicted using respondent and patient
characteristics. If these data were reflected in clinical practice some
patients may not be offered helpful palliative treatment options.
KEYWORDS:
Advanced cancer, general practitioners, palliative treatment, radiotherapy, structured vignette survey.
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