title: Pre-referral general practitioner consultations and subsequent experience of cancer care: evidence from the English Cancer Patient Experience Survey.
abstract: Prolonged diagnostic intervals may negatively affect the patient experience of subsequent cancer care, but evidence about this assertion is sparse. We analysed data from 73 462 respondents to two English Cancer Patient Experience Surveys to examine whether patients with three or more (3+) pre-referral consultations were more likely to report negative experiences of subsequent care compared with patients with one or two consultations in respect of 12 a priori selected survey questions. For each of 12 experience items, logistic regression models were used, adjusting for prior consultation category, cancer site, socio-demographic case-mix and response tendency (to capture potential variation in critical response tendencies between individuals). There was strong evidence (P < 0.01 for all) that patients with 3+ pre-referral consultations reported worse care experience for 10/12 questions, with adjusted odds ratios compared with patients with 1-2 consultations ranging from 1.10 (95% confidence intervals 1.03-1.17) to 1.68 (1.60-1.77), or between +1.8% and +10.6% greater percentage reporting a negative experience. Associations were stronger for processes involving primary as opposed to hospital care; and for evaluation than report items. Considering 1, 2, 3-4 and '5+' pre-referral consultations separately a 'dose-response' relationship was apparent. We conclude that there is a negative association between multiple pre-diagnostic consultations with a general practitioner and the experience of subsequent cancer care.
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Mendonca
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK.
authors.forename: G A
authors.initials: GA
authors.lastname: Abel
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK.|RAND Europe, Cambridge, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Saunders
authors.affiliation: Department of Epidemiology & Public Health, Health Behaviour Research Centre, University College London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK.|Department of Epidemiology & Public Health, Health Behaviour Research Centre, University College London, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lyratzopoulos
mesh_terms: D000328:Adult; D000368:Aged; D004739:England; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D035502:Trust
keywords: cancer; consultation; general practitioner; oncology; patient experience; referral