title: General practitioner referral patterns for women with gynaecological symptoms: a randomised incomplete block study design.
abstract: OBJECTIVE
  To describe why, when and to whom general practitioners refer women with symptoms possibly attributable to cervical, endometrial or ovarian cancers, and to identify patient and GP factors that predict referral to either a gynaecologist or a gynaecological oncologist.
  
  
  METHODS
  A national survey of GPs between 1 April and 31 August 2009 using a randomised incomplete block design based on case vignettes, and using a self-completed postal or online questionnaire.
  
  
  METHODS
  A sample of GPs, stratified by location and randomly selected from a database of GPs maintained by the Australasian Medical Publishing Company.
  
  
  METHODS
  Proportion of vignettes that were deemed to reflect a high probability of cancer being referred; and the patient and clinician factors that were the strongest predictors of referral.
  
  
  RESULTS
  Of the 3082 GPs who were selected for participation, 1402 responded, giving a response rate of 45.5%. Overall, for vignettes identified as describing women with a high probability of cancer, 75% were referred by metropolitan GPs and 73% by rural practitioners. Metropolitan GPs were significantly more likely to refer women in scenarios indicative of endometrial cancer than rural GPs. For all three cancers, GPs were significantly more likely to refer a patient to a gynaecologist (between 70.8% and 95.4%) than a gynaecological oncologist. Metropolitan GPs had significantly greater access to both private and public gynaecological oncologists than their rural counterparts. Referral rates were higher for ovarian and cervical cancer (83% and 80%, respectively) and lower for endometrial cancer (68%). For all three cancers, patient factors were stronger predictors of referral than the demographic factors of participating GPs.
  
  
  CONCLUSIONS
  There appears to be significant variation in referral practices among GPs and this variation is greater for endometrial cancer, for which there are currently no evidence-based clinical practice guidelines in Australia. There is a need for further research into understanding the basis of these differences, including a review of the existing guidelines for ovarian and cervical cancer and the development of guidelines for endometrial cancer.
authors: Hunter Valley Research Foundation, Newcastle, NSW, Australia. shanthi@hvrf.com.au
authors: Shanthi A
authors: SA
authors: Ramanathan
authors: Genevieve
authors: G
authors: Baratiny
authors: Nigel P
authors: NP
authors: Stocks
authors: Andrew M
authors: AM
authors: Searles
authors: Russell J
authors: RJ
authors: Redford
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D001315:Australia; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D005833:Genital Neoplasms, Female / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006176:Gynecology / Q000706:statistics & numerical data*; D006801:Humans; D016013:Likelihood Functions; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011237:Predictive Value of Tests; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012044:Regression Analysis; D018570:Risk Assessment; D012424:Rural Population; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D014505:Urban Population