Avtor/Urednik		Murchie, Peter; Khor, Wei Lynn; Adam, Rosalind; Esteva, Magdalena; Smyrnakis, Emmanouil; Petek, Davorina; Thulesius, Hans; Vedsted, Peter; McLernon, David; Harris, Michael
Naslov		Influences of rurality on action to diagnose cancer by primary care practitioners - results from a Europe-wide survey in 20 countries
Tip		članek
Leto izdaje		2020
Obseg		str. str.
ISSN		1877-7821 - Cancer epidemiology
Jezik		eng
Abstrakt		Background: Rural-dwellers have poorer cancer outcomes than urban counterparts, for reasons which are un-clear. At healthcare institution level, poorer access to investigations and different clinical decision-making byrural primary healthcare practitioners (PCPs) could be important. Aim: To compare access to investigations, attitudes to cancer diagnosis and clinical decision-making between rural and urban PCPs. Setting: A vignette-based cross-sectional survey of rural and urban PCPs in 20 European countries. Methods: Data on PCPs decision-making and attitudes to cancer diagnosis were based on clinical scenarios. Comparisons were made using tests of proportion, univariable and multivariable binary logistic regression.Results: Of the 1779 PCPs completing the survey 541 30.4 %) practiced rurally. Rural PCPs had significantly lessdirect access to all investigative modalities: ultrasound; endoscopy; x-ray and advanced screening (allp < 0.001). Rural PCPs were as likely as urban PCPs to take diagnostic action (investigation and/or referral) atthe index consultation in all four clinical vignettes ((OR, 95% CI) for lung: 0.90, 0.72-1.12; ovarian: 0.95,0.75-1.19; breast: 0.87, 0.69-1.09; colorectal: 0.98, 0.75-1.30). Rural PCPs were less likely to refer to a specialist at the index consultation for ovarian cancer (OR 0.71 95 % CI 0.51-0.99). Rural PCPs were significantly more likely to report that their patients faced barriers to accessing specialist care, but practitioners did not reportgreater difficulties making specialist referral than their urban counterparts Conclusions: European rural PCPs report poorer access to investigations but are at least as likely as urban PCPs toinvestigate or refer patients that might have cancer at the index consultation.
Proste vsebinske oznake		primary healthcare cancer cancer diagnostics influences of rurality primarno zdravstveno varstvo diagnostika raka vplivi podeželja