Availability of cancer decision-support tools: A cross-sectional survey of UK primary care

Abstract

Background Decision-support tools quantify the risk of undiagnosed cancer in symptomatic patients, and may help general practitioners (GPs) when making referrals. Aims: To quantify the availability and use of cancer decision-support tools (QCancer® and Risk Assessment Tools). To explore the association between tool availability and two-week-wait referrals for suspected cancer. Design and setting: Cross-sectional postal survey in UK primary care. Methods: 4,600 GPs from a random sample of 975 UK general practices were invited to participate. Outcome measures included the proportions of UK general practices where: (1) cancer decision-support tools are available, and (2) at least one GP uses the tool. Weighted least-squares linear regression with robust errors tested the association between tool availability and number of two-week-wait referrals, adjusting for practice size, sex, age and index of multiple deprivation. Results: 476 GPs in 227 practices responded (response rates: practitioner, 10.3%; practice, 23.3%). Cancer decision-support tools were available in 83/227 (36.6%, 95% confidence interval 30.3% to 43.1%) practices. Tools were available and likely to be used in 38/227 (16.7%, 12.1% to 22.2%) practices. In sub-group analyses of 172 English practices, there was no difference in mean two-week-wait referral rate between practices with tools and those without (mean adjusted difference in referrals per 100,000: 3.1, -5.5 to +11.7). Conclusions: This is the first survey of cancer decision-support tool availability and use. It suggests that the tools are an underused resource in the UK. Given the cost of cancer investigation, a randomised controlled trial of such clinical decision-support aids would be appropriate.