Qualität in der Primärversorgung Offener Zugang

Abstrakt

Advice to consult a general medical practitioner in Western Australia: could it be cancer?

Moyez Jiwa, Georgia Halkett, Hayley Arnet, Marthe Smith, Ruth McConigley, David Lim, Max Bulsara, Akil Islam

Background Many people will consult a medical practitioner about lower bowel symptoms, and the demand for access to general practitioners (GPs) is growing. We do not know if people recognise the symptoms of lower bowel cancer when advising others about the need to consult a doctor. A structured vignette survey was conducted in Western Australia. Method Participants were recruited from the waiting rooms at five general practices. Respondents were invited to complete self-administered questionnaires containing nine vignettes chosen at random from a pool of 64 based on six clinical variables. Twenty-seven vignettes described high-risk bowel cancer scenarios. Respondents were asked if they would recommend a medical consultation for the case described and whether they believed the scenario was a cancer presentation. Logistic regression was used to estimate the independent effects of each variableonthe respondent’s judgement.Two-hundred and sixty-eight completed responses were collected over eight weeks. Results The majority (61%) of respondents were female, aged 40 years and older. A history of rectal bleeding, six weeks of symptoms, and weight loss independently increased the odds of recommending a consultation with a medical practitioner by a factor of 7.64, 4.11 and 1.86, respectively.Most cases that were identified as cancer (75.2%) would not be classified as such on current research evidence.  Factors that predict recognition of cancer presentations include rectal bleeding, weight loss and diarrhoea. Conclusion Within the limitation of this study, respondents recommended that most symptomatic people present to their GP. However, we report no evidence that they recognised a cancer presentation, and duration of symptoms was not a significant variable in this regard. Cases that were identified as ‘cancer’ could not be classified as high risk on the available evidence.