Module 3: Beliefs, behaviours and systems in primary care

Module 3 looks specifically at the role of primary care in diagnosing cancer.  It explores the attitudes and beliefs of General Practitioners (GPs) and also examines differences in primary care systems involved in diagnosing cancer.  The aim of module 3 is to understand international differences in primary care that may impact on cancer survival. Together with the analyses from the other ICBP modules, results from Module 3 will inform healthcare policy in the UK in order to improve the number of people surviving from cancer.

The Primary Care Physician survey

An international group, led by Dr Peter Rose in England, has developed this survey. It will provide an insight into the contribution of variation in primary care management of symptoms to cancer outcomes. It consists of two parts:

• A set of general questions relating to GP practice administration, access to diagnostics, training and education and availability of advice from secondary care.  Some jurisdictions will also collect data on questions which are relevant to specific local issues, for example detail on clinical guidelines.
• Two patient vignettes. The physician is asked to make choices about management in response to the presentation of the patient. The patient may or may not have cancer and this will be revealed at the end of the vignette. The vignettes aim to draw out any differences in the approach of primary care physicians to patients with these symptoms.

200 GPs per jurisdiction will be surveyed in each jurisdiction. The approach to sampling will vary in each jurisdiction due to differences in the availability of the contact details for primary care physicians.

The survey has now been rolled out to all 11 jurisdictions. Data collection is expected to be complete by the end of May 2013, with a publication of the findings expected in the autumn of 2013. 

Healthcare Systems Mapping

Professor Greg Rubin is leading a healthcare systems mapping exercise alongside the survey. This will provide insight into variations in systems that might impact on the GP survey and help to analyse emerging trends.  Desktop research combined with structured interviews of “key informants” from each jurisdiction will be used to map the context in which primary care physicians work. This includes looking at which financial and non-financial incentives GPs receive and what their actual diagnostic access is. The systems mapping exercise is expected to be completed and a paper will be submitted for publication in a peer reviewed journal in spring 2013. A copy of the full systems mapping report will be available in due course on the ICBP publications page. 

Module 3 is funded by contributions from each participating jurisdiction. It is chaired by Dr Peter Rose of Oxford University. The central team also includes Professor Willie Hamilton of the Peninsular Medical School and Professor Greg Rubin of Durham University. Programme Managers at Cancer Research UK support the team.

Module 3 governance

The ICBP Programme Board oversees the work of this module and the partnership overall.  The central team leads Module 3 and is collaborating closely with a group of international collaborators (outlined below). An independent academic reference group has been appointed to provide peer review on methodology, analyses and conclusions.

International Collaborators

• Australia, Victoria – Marie Pirotta 
• Australia, New South Wales - Jane Young
• Canada, Ontario – Eva Grunfeld, Andriana Barisic
• Canada, British Columbia - Martin Dawes, Jin Mou
• Canada, Manitoba – Jeff Sisler, Breann Hawryluk, Gerald Konrad
• Denmark - Peter Vedsted, Berit Toftegard
• England - Peter Rose, Rafael Perera-Salazar
• Northern Ireland - Nigel Hart
• Norway - Anne Kari Knudsen, Sigrun Saur Almberg
• Sweden - Hans Thulesius, Magdalena Lagerlund
• Wales – Richard Neal

Academic Reference Group
 

• Professor Roger Jones (Kings College London, UK) 
• Professor Niek de Wit (University of Utrecht, the Netherlands) 
• Professor Jon Emery (University of Western Australia, Australia) 
• Professor Frede Olesen (Aarhus University, Denmark) 
• Professor Jean Muris (Maastricht University, the Netherlands)