title: Evaluation of risk assessment tools for suspected cancer in general practice: a cohort study.
abstract: BACKGROUND
  Diagnostic delay is deemed to account for an estimated 5000 to 10 000 extra cancer deaths each year in the UK. Many cancer patients do not have symptoms meeting national referral criteria for rapid investigation. Risk assessment tools (RATs) have been developed  to assist GPs in selecting patient for cancer investigation.
  
  
  OBJECTIVE
  To assess the usability and acceptability of lung and colorectal RATs, as well as subsequent resource use and cancer diagnoses.
  
  
  METHODS
  Cohort study with nested qualitative study  with 614 GPs from 165 practices in seven English cancer networks were provided with RATs applicable to patients aged ≥40 years with bowel or respiratory symptoms. In-depth interviews were conducted with 34 individuals (11 project managers and 23 GPs).
  
  
  METHODS
  The study  measured the number of RATs used, and subsequent cancer investigations and diagnoses, over a 6-month period and compared these with the previous 6 months.
  
  
  RESULTS
  A total of 2593 RATs (1160 lung, 1433 colorectal) were completed. Compared with the preceding 6 months, there  were 292 more chest X-rays, 104 extra 2-week chest clinic appointments, and 47 additional diagnoses of lung cancer. For suspected colorectal cancer, there were 304 more 2-week referrals, 270 more colonoscopies, and 10 more cancers identified. RATs appeared to help GPs in their selection of  patients for cancer investigation. Users reported that RATs helped to confirm a need for investigation as well as allowing reassurance when investigation was not needed.
  
  
  CONCLUSIONS
  Use of RATs in primary care was accompanied by increased diagnostic activity and additional  cancer diagnoses.
authors: Primary Care Diagnostics, Veysey Building, Exeter, UK. willie.hamilton@pcmd.ac.uk
authors: William
authors: W
authors: Hamilton
authors: Trish
authors: T
authors: Green
authors: Tanimola
authors: T
authors: Martins
authors: Kathy
authors: K
authors: Elliott
authors: Greg
authors: G
authors: Rubin
authors: Una
authors: U
authors: Macleod
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D058006:General Practice / Q000379:methods / Q000458:organization & administration / Q000592:standards; D019538:Health Care Surveys; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology