title: How do general practitioners manage patients with cancer symptoms? A video-vignette study.
abstract: OBJECTIVE
  Determine how general practitioners (GPs) manage patients with cancer symptoms.
  
  
  METHODS
  GPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to available guidelines, all cases warranted a referral to a specialist or further investigations.
  
  
  METHODS
  Australian primary care sector.
  
  
  METHODS
  102 practising GPs participated in this study, including trainees.
  
  
  METHODS
  The research was part of a larger randomised controlled trial testing a referral pro forma; however, this paper reports on management decisions made throughout the study.
  
  
  METHODS
  This paper reports on how the participants would manage the patients depicted in each vignette.
  
  
  RESULTS
  In more than one-in-eight cases, the patient was not investigated or referred. Patient management varied significantly by cancer type (p<0.001). For two key reasons, colorectal cancer was the chosen referent category. First, it represents a prevalent type of cancer. Second, in this study, colorectal cancer symptoms were managed in a similar proportion of options-that is, prescription, referral or investigation. Compared with vignettes featuring colorectal cancer participants were less likely to manage breast, bladder, endometrial, and lung cancers with a 'prescription only' or 'referral only' option. They were less likely to manage prostate cancer with a 'prescription only', yet more likely to manage it with a 'referral with investigation'. With regard to pancreatic and cervical cancers, participants were more likely to manage these with a 'referral only' or a 'referral with investigation'.
  
  
  CONCLUSIONS
  Some patients may receive a delayed cancer diagnosis, even when they present with typical cancer symptoms to a GP who can access relevant diagnostic tests.
  
  
  BACKGROUND
  ACTRN12611000760976.
authors.affiliation: Melbourne Clinical School, School of Medicine Sydney, University of Notre Dame, Werribee, Victoria, Australia.
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.affiliation: School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Xingqiong
authors.initials: X
authors.lastname: Meng
authors.affiliation: Victorian Metropolitan Alliance, Hawthorn, Victoria, Australia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: O'Shea
authors.affiliation: Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
authors.affiliation: School of Business, University of Western Sydney, Parramatta, New South Wales, Australia.
authors.forename: Ann
authors.initials: A
authors.lastname: Dadich
authors.affiliation: Department of Medical Education, Curtin University, Perth, Western Australia, Australia.
authors.forename: Vinita
authors.identifier: http://orcid.org/0000-0003-3663-0138
authors.initials: V
authors.lastname: Pillai
mesh_terms: D000328:Adult; D001315:Australia; D057210:Delayed Diagnosis; D019468:Disease Management; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification* / Q000175:diagnosis*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012017:Referral and Consultation
keywords: MEDICAL HISTORY; ONCOLOGY; PRIMARY CARE