Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus C, Denmark.
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus C, Denmark.
BMC Fam Pract. 2021 Jun 24;22(1):129. doi: 10.1186/s12875-021-01480-2.
General practitioners (GPs) have a key role in the diagnosis of cancer. It is crucial to identify factors influencing the decision to refer for suspected cancer. The aim of this study was to investigate the alignment between the patient's cancer worry and the GP's suspicion of cancer in the first clinical encounter and the association with the time interval from the first symptom presentation until the first referral to specialist care, i.e. the primary care interval (PCI).
The study was performed as a cross-sectional study using survey data on patients diagnosed with incident cancer in 2010 or 2016 and their GPs in Denmark. We defined four alignment groups: 1) patient worry and GP suspicion, 2) GP suspicion only, 3) patient worry only, and 4) none of the two. A long PCI was defined as an interval longer than the 75th percentile.
Among the 3333 included patients, both patient worry and GP suspicion was seen in 39.5%, only GP suspicion was seen in 28.2%, only patient worry was seen in 13.6%, and neither patient worry nor GP suspicion was seen in 18.2%. The highest likelihood of long PCI was observed in group 4 (group 4 vs. group 1: PPR 3.99 (95% CI 3.34-4.75)), mostly pronounced for easy-to-diagnose cancer types.
Misalignment between the patient's worry and the GP's suspicion was common at the first cancer-related encounter. Importance should be given to the patient interview, due to a potential delayed GP referral among patients diagnosed with "easy-to-diagnose" cancer types presenting with unspecific symptoms.
全科医生（GP）在癌症诊断中起着关键作用。确定影响怀疑癌症转诊决策的因素至关重要。本研究旨在调查首次临床就诊时患者的癌症担忧与 GP 对癌症的怀疑之间的一致性，以及与从首次出现症状到首次转至专科治疗的时间间隔（即初级保健间隔（PCI））的关联。
该研究采用丹麦 2010 年或 2016 年确诊癌症的患者及其 GP 的横断面调查数据进行。我们定义了四个一致性组：1）患者担忧和 GP 怀疑，2）仅 GP 怀疑，3）仅患者担忧，4）两者均无。长 PCI 定义为间隔超过第 75 百分位数。
在纳入的 3333 名患者中，39.5%同时存在患者担忧和 GP 怀疑，28.2%仅存在 GP 怀疑，13.6%仅存在患者担忧，18.2%两者均无。最长 PCI 的可能性最高见于第 4 组（第 4 组与第 1 组相比：PPR 3.99（95%CI 3.34-4.75）），在易诊断癌症类型中最为明显。
在首次与癌症相关的就诊时，患者的担忧与 GP 的怀疑之间存在不一致的情况很常见。由于易诊断癌症类型的患者出现非特异性症状，GP 可能会延迟转诊，因此应重视对患者的问诊。
