What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study

Funding Information: The publication of the article in OA mode was financially supported by HEAL-Link. Publisher Copyright: © The Author(s), 2022.Background: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. Aim: To identify the factors that affect European GPs' empowerment in making an early diagnosis of cancer. Methods: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale. The final list of statements indicated those that were considered by consensus to be the most relevant. Results: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs' working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. Conclusion: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.publishersversionPeer reviewe

What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study.

BACKGROUND Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. AIM To identify the factors that affect European GPs' empowerment in making an early diagnosis of cancer. METHODS This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale.The final list of statements indicated those that were considered by consensus to be the most relevant. RESULTS In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs' working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. CONCLUSION GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis

Effect of being a training practice on outcomes related to the safety culture of primary care practices in the PRICOV-19 study

Introduction: COVID-19 introduced substantial changes to family practices' daily work. Teaching practices needed to adapt both in terms of clinical work and teaching in a way that enabled the teaching process, while maintaining safe and high quality care. This included safety measures for patients, clinicians and trainees, as well as outreach activities to the vulnerable patient populations, while also affecting the wellbeing of teachers and trainees. Previous research has shown higher quality care provided in teaching practices. Our study aimed to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of a primary care practice. Method: PRICOV-19 is a multi-country cross-sectional study that researched how primary care practices were organized during the pandemic. Data collection happened from November 2020 to December 2021. We categorized practices in training and non-training and selected outcomes from the database that related from the following dimensions of safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. We built mixed-effects regression models to analyze the effect of being a training practice in each of the outcomes, while controlling for relevant confounders. Results: We had 2889 (56%) non-training practices and 2272 (44%) training practices in our database. Being a training practice had a significant association with lower risk for adverse mental health events (OR: 0.74; CI:0.62-0.89), higher number of safety measures related to patient flow (Beta: 0.20; CI: 0.09-0.31), higher chance of outreach initiatives (RR: 1.07; CI:1.01-1.14), higher number of safety incidents reported (RR: 1.11; CI:1.05-1.18) and more protected time for meetings (Beta: 0.11; CI:0.04-0.17). No significant associations were found for infection prevention equipment, availability of triage information, use of a phone protocol, infection prevention measures. Conclusions: In our sample, training practices appear to have a stronger safety culture than non-training practices

Distress and wellbeing among general practitioners during COVID-19 : supports required based on the results from the cross-sectional PRICOV-19 study

Introduction: Emerging literature from all around the world is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior the crisis, the wellbeing of this group was already of concern. Burnout is the most extreme form of this lack of wellbeing and its symptoms not only has a direct impact on the physician, but also on patients. Some studies have shown that, among physicians who report experiencing at least some signs of burnout, family medicine and emergency medicine physicians are among those at highest risk. Aim To describe the frequency of distress and wellbeing, measured by the Mayo Clinic Wellbeing index, among general practitioners and family physicians during the COVID-19 pandemic and to identify some of the key levers that could potentially mitigate the risk of distress. Method: Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software on Version 7 of the database which was the version consisting of the cleaned data of 33 countries available as of November 3rd, 2021. Results: Data from 3,711 was included. MCWI scores ranged from -2 to 9 with a mean of 2.7 and median of 3. Using a cut off of ≥2, 64.5% of respondents are considered at risk. GPs with less experience, in smaller practices, and with more vulnerable patient populations have lower well-being scores and hence are at a higher risk of distress. Collaboration from other practices and adequate governmental support are significant protective factors for distress. Conclusions: While individual factors are important, it is necessary to address practice and system level organizational factors in order to enhance wellbeing and support primary care physicians. Research on the impact of such interventions is required

European general practitioners’/family physicians’ attitudes towards person-centered care and factors that influence its implementation in everyday practice : preliminary results

Background: Person-centered care (PCC) is widely acknowledged as a core value in family medicine and has been associated with many positive outcomes of care. There has been no comparison of GPs attitudes towards person-centeredness across European countries. Research questions: To investigate GPs/FPs attitudes towards person-centeredness. To understand GPs/FPs facilitators and barriers related to practicing PCC. To document obstacles to practicing PCC in practice. Method: A cross-sectional questionnaire-based study across 22 European countries (finished in one country, in 10 countries ongoing, in 11 countries finishing the preparatory phase). In each country, the population of GPs/FPs will be reached through the official mailing list of the national medical associations. The study instrument consists of four parts: General information about the doctor and the doctor's office, Perceived Stress Scale (PSS), Patient Practitioner Orientation Scale (PPOS) and Facilitators and barriers to PCC in everyday practice. The Ethics Committee, School of Medicine, University of Zagreb approved the project. The study will be carried out in close collaboration with the European Association for Quality and Patient Safety in Primary Care (EQuiP) and the European General Practice Research Network (EGPRN). The study will be coordinated by the Department of Family Medicine, School of Medicine University of Zagreb (Croatia). The project is supported by the EGPRN Grant. Results: GPs/FPs attitudes towards person-centeredness will be described and investigated in correlation to sociodemographic data and work stress in each participating European country. GPs/FPs facilitators and barriers to practicing PCC in everyday practice will be analysed. Data will be analysed using software package STATISTICA 7.1 (StatSoft Inc, Tulsa, OK, USA), and P < .05 will be considered statistically significant. Conclusions: Regardless of the specific context of care that is highly dependent on the patient, physician and healthcare system characteristics, PCC represents a core value of family medicine that should be implemented in GPs/FPs everyday work across Europe