Background
Methods
Setting
Intervention: continuing medical education
Overall study design and recruitment of GPs
Questionnaire data
GP knowledge
GP attitude
GP readiness to investigate
GP cancer risk assessment of urgently referred patients
Analyses
Results
Study population
GP characteristics | ||||
---|---|---|---|---|
N (%) | Mean age Years (95 % CI) | Proportion of males % (95 % CI) | Proportion of solo GPs % (95 % CI) | |
Study base | ||||
Total | 831 (100) | 52.3 (51.7; 52.8) | 54.3 (50.9; 57.7) | 24.1 (21.2; 27.0) |
Reference GPs | 634 (76.3) | 52.4 (51.7; 53.0) | 56.5 (52.6; 60.3) | 26.0 (22.6; 29.4) |
CME-participating GPs | 197 (23.7) | 51.9 (50.8; 53.0) | 47.2 (40.2; 54.2) | 17.8 (12.4; 23.2) |
GPs that completed knowledge and attitudes items | ||||
Reference GPs | 121 (19.1) | 49.8 (48.3; 51.4) | 57.9 (48.9; 66.8) | 24.0 (16.3; 31.7) |
CME-participating GPs | 81 (41.1) | 50.7 (48.8; 52.5) | 46.9 (35.8; 58.0) | 18.5 (9.9; 27.2) |
GPs that completed vignettes | ||||
Reference GPs | 116 (18.3) | 49.9 (48.4; 51.5) | 58.6 (49.5; 67.7) | 23.3 (15.5; 31.1) |
CME-participating GPs | 80 (40.6) | 50.5 (48.7; 52.4) | 47.5 (36.3; 58.7) | 18.8 (10.0; 27.5) |
GPs that assessed risk of cancer on urgently referred patients | ||||
Reference GPs, before | 384 (60.6) | 51.6 (50.8; 52.4) | 52.6 (47.6; 57.6) | 26.8 (22.4; 31.3) |
Reference GPs, after | 364 (57.4) | 51.7 (50.8; 52.6) | 53.6 (48.4; 58.7) | 22.3 (18.0; 26.5) |
CME-participating GPs, before | 148 (75.1) | 51.6 (50.3; 52.9) | 45.9 (37.8; 54.1) | 17.6 (11.4; 23.8) |
CME-participating GPs, after | 160 (81.2) | 51.9 (50.6; 53.1) | 46.9 (39.1; 54.7) | 15.6 (9.9; 21.3) |
CME effect on GP attitude
Reference group | CME-Participating group | Comparison between groups | ||||||
---|---|---|---|---|---|---|---|---|
N = 121 |
N = 81 | |||||||
Most appropriate answers | Before | After | Before vs. after | Before | After | Before vs. after | RR1/RR0 (p*) | |
% (n) | % (n) | RR0 (p*) | % (n) | % (n) | RR1 (p*) | |||
If a patient referred by me to a cancer fast-track pathway turns out not to have cancer, it is overuse of health services. |
Strongly disagree - disagree
| 86.8 (105) | 84.3 (102) | 0.97 (0.419) | 81.5 (66) | 87.7 (71) | 1.08 (0.163) | 1.11 (0.241) |
If a patient referred by me to a cancer fast-track pathway turns out not to have cancer, unnecessary strain has been placed on the patient. |
Strongly disagree - disagree
| 83.5 (101) | 79.3 (96) | 0.95 (0.221) | 75.3 (61) | 79.0 (64) | 1.05 (0.275) | 1.11 (<0.001)
|
The more of the patients referred by me to a cancer fast-track pathway turn out to have cancer, the better a doctor I am. |
Strongly disagree - disagree
| 57.9 (70) | 62.0 (75) | 1.07 (0.224) | 59.3 (48) | 79.0 (64) | 1.33 (0.003) | 1.24 (0.013)
|
I am a good doctor when I refer a patient to a cancer fast-track pathway based on a reasonable suspicion, as it quickly clarifies the suspicion. |
Strongly agree- agree
| 81.0 (98) | 81.8 (99) | 1.01 (0.823) | 86.4 (70) | 82.7 (67) | 0.96 (0.397) | 0.95 (0.537) |
I am reluctant to order tests because of the risk of over-diagnosis. |
Strongly disagree - disagree
| 75.2 (91) | 75.2 (91) | 1.00 (1.000) | 71.6 (58) | 75.3 (61) | 1.05 (0.308) | 1.05 (0.314) |
I find it hard to mention cancer suspicion to a patient with alarm symptoms of cancer. |
Strongly disagree - disagree
| 81.0 (98) | 83.5 (101) | 1.03 (0.402) | 74.1 (60) | 75.3 (61) | 1.02 (0.704) | 1.00 (0.813) |
I feel well prepared to communicate with the cancer pathway coordinators. |
Strongly agree- agree
| 82.6 (100) | 78.5 (95) | 0.95 (0.224) | 79.0 (64) | 77.8 (63) | 0.98 (0.806) | 1.03 (0.697) |
CME effect on GP knowledge about cancer diagnosis
Reference group | CME Participating group | Comparison between groups | ||||||
---|---|---|---|---|---|---|---|---|
N = 121 |
N = 81 | |||||||
MAAA | Before | After | Before vs. after | Before | After | Before vs. after | RR1/RR0 (p*) | |
% (n) | % (n) | RR0 (p*) | % (n) | % (n) | RR1 (p*) | |||
What is the likelihood that a 50-year-old patient having cancer at the time you choose to refer the patient to a cancer fast-track pathway? | 2–10 % | 29.8 (36) | 38.8 (47) | 1.31 (<0.001)
| 23.5 (19) | 65.4 (53) | 2.79 (<0.001)
| 2.13 (0.009)
|
What is the likelihood that a patient aged 40 years or more, who is smoker, has lung cancer the second time s/he presents with haemoptysis in your practice? | 5–20 % | 33.1 (40) | 34.7 (42) | 1.05 (0.698) | 33.3 (27) | 58.0 (47) | 1.74 (0.010)
| 1.63 (0.160) |
What is the likelihood that a patient aged 40 years or more has colorectal cancer the first time that s/he presents with unintended weight loss and new onset of constipation in your practice? | 2–6 % | 8.3 (10) | 9.9 (12) | 1.19 (0.039)
| 6.2 (5) | 28.4 (23) | 4.6 (<0.001)
| 3.83 (0.055) |
What is the likelihood that a lung cancer cannot be detected on a chest x-ray at the time of diagnosis? | ≥15 % | 81.8 (99) | 86.0 (104) | 1.05 (0.741) | 76.5 (62) | 81.5 (66) | 1.06 (0.243) | 1.07 (0.309) |
What is the proportion of patients with colorectal cancer who presented an alarm symptom as the first sign of the disease to his/her general practitioner? | ≤60 % | 81.8 (99) | 86.0 (104) | 1.05 (0.449) | 82.7 (67) | 90.1 (73) | 1.09 (0.006)
| 1.04 (0.614) |
What is the proportion of patients with ovarian cancer who can be detected by a pelvic examination (palpation) in general practice at the time of diagnosis? | ≤41 % | 90.0 (110) | 94.2 (114) | 1.04 (0.078) | 85.2 (69) | 92.6 (75) | 1.09 (0.012)
| 1.05 (0.322) |
CME effect on GP readiness to investigate (vignettes)
Reference group N (vignettes) = 232 N (GPs) = 116 | CME-participating group N (vignettes) = 160 N (GPs) = 80 | Comparison between groups | |||||
---|---|---|---|---|---|---|---|
Before | After | Before vs. after | Before | After | Before vs. after | OR1/OR0* (p) | |
% (n) | % (n) | OR0* (p) | % (n) | % (n) | OR1* (p) | ||
Definitive action, at the end of first phase | 37.9 (88) | 40.1 (93) | 1.19 (0.444) | 36.9 (59) | 43.8 (70) | 1.70 (0.055) | 1.43 (0.316) |
Definitive action, at the end of second phase | 77.2 (179) | 77.6 (180) | 1.04 (0.872) | 81.9 (131) | 88.8 (142) |
2.02 (0.043)
| 1.94 (0.119) |
CME effect on GP cancer risk assessment of urgently referred patients
Reference group | CME-participating group | Comparison between groups | |||||
---|---|---|---|---|---|---|---|
N = 634 |
N = 197 | ||||||
Before | After | Before vs. after | Before | After | Before vs. after | Regression coefficient* (p) | |
Regression coefficient* (p) | Regression coefficient * (p) | ||||||
GPs (n (%)) | 384 (60.6) | 364 (57.4) | 148 (75.1) | 160 (81.2) | |||
Patients (n) | 1740 | 1276 | 610 | 838 | |||
Median risk (% (IQI)) | 30 (10–50) | 30 (10–50) | 30 (10–50) | 15 (10–50) | |||
Mean risk (% (95 % CI)) | 39.6 (38.1; 41.0) | 38.8 (37.1; 40.4) | −0.17 (0.063) | 39.0 (36.6; 41.4) | 27.4 (25.6; 29.3) | −1.10 (<0.001)
| −0.93 (<0.001)
|