Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.
Centre for Health Technology and Services Research, Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal.
BMC Health Serv Res. 2023 Sep 16;23(1):997. doi: 10.1186/s12913-023-09891-w.
Diagnosing cancer at an early stage increases the likelihood of survival, and more advanced cancers are more difficult to treat successfully. Primary care practitioners (PCPs) play a key role in timely diagnosis of cancer. PCPs' knowledge of their own patient populations and health systems could help improve the planning of more effective approaches to earlier cancer recognition and referral. How PCPs act when faced with patients who may have cancer is likely to depend on how their health systems are organised, and this may be one explanation for the wide variation on cancer survival rates across Europe.
To identify and characterise clusters of countries whose PCPs perceive the same factors as being important in improving the timeliness of cancer diagnosis.
A cluster analysis of qualitative data from an online survey was carried out. PCPs answered an open-ended survey question on how the speed of diagnosis of cancer in primary care could be improved. Following coding and thematic analysis, we identified the number of times per country that an item in a theme was mentioned. k-means clustering identified clusters of countries whose PCPs perceived the same themes as most important. Post-hoc testing explored differences between these clusters.
Twenty-five primary care centres in 20 European countries. Each centre was asked to recruit at least 50 participants.
Primary care practitioners of each country.
In all, 1,351 PCPs gave free-text answers. We identified eighteen themes organising the content of the responses. Based on the frequency of the themes, k-means clustering identified three groups of countries. There were significant differences between clusters regarding the importance of: access to tests (p = 0.010); access to specialists (p = 0.014), screening (p < 0.001); and finances, quotas & limits (p < 0.001).
Our study identified three distinct clusters of European countries within which PCPs had similar views on the factors that would improve the timeliness of cancer diagnosis. Further work is needed to understand what it is about the clusters that have produced these patterns, allowing healthcare systems to share best practice and to reduce disparities.
早期诊断癌症可提高生存几率，而晚期癌症则更难成功治疗。初级保健医生（PCP）在癌症的及时诊断中发挥着关键作用。PCP 对其患者群体和卫生系统的了解有助于改进更有效的早期癌症识别和转诊方法的规划。PCP 在面对可能患有癌症的患者时的行为方式可能取决于其卫生系统的组织方式，这可能是欧洲各地癌症存活率差异很大的一个原因。
确定并描述一组国家，这些国家的 PCP 认为同样的因素对于提高癌症诊断的及时性很重要。
对在线调查的定性数据进行聚类分析。PCP 回答了一个关于如何提高初级保健中癌症诊断速度的开放性调查问题。在进行编码和主题分析后，我们确定了每个主题在每个国家/地区被提及的次数。k-均值聚类确定了 PCP 认为最重要的主题相同的国家/地区的聚类。事后检验探讨了这些聚类之间的差异。
20 个欧洲国家的 25 个初级保健中心。每个中心被要求招募至少 50 名参与者。
每个国家的初级保健医生。
共有 1351 名 PCP 提供了自由文本答案。我们确定了组织回答内容的 18 个主题。基于主题的频率，k-均值聚类确定了三组国家。在以下方面，各组之间存在显著差异：测试的可及性（p=0.010）；专家的可及性（p=0.014），筛查（p<0.001）；财务、配额和限制（p<0.001）。
我们的研究确定了欧洲三个不同的国家集群，其中 PCP 对提高癌症诊断及时性的因素有相似的看法。需要进一步研究了解是什么原因导致了这些集群的出现，以便医疗保健系统能够分享最佳实践并减少差异。
Zotero 插件
