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oai:repisalud.isciii.es:20.500.12105/229072024-11-28T19:50:02Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16967

00925njm 22002777a 4500 dc Murchie, Peter author Khor, Wei Lynn author Adam, Rosalind author Esteva, Magdalena author Smyrnakis, Emmanouil author Petek, Davorina author Thulesius, Hans author Vedsted, Peter author McLernon, David author Harris, Michael author 2020-04 Background: Rural-dwellers have poorer cancer outcomes than urban counterparts, for reasons which are unclear. At healthcare institution level, poorer access to investigations and different clinical decision-making by rural 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 less direct access to all investigative modalities: ultrasound; endoscopy; x-ray and advanced screening (all p<0.001). Rural PCPs were as likely as urban PCPs to take diagnostic action (investigation and/or referral) at the 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 report greater 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 to investigate or refer patients that might have cancer at the index consultation. Murchie Peter, Khor Wei Lynn, Adam Rosalind, Esteva Magdalena, Smyrnakis Emmanouil, Petek Davorina, et al. Influences of rurality on action to diagnose cancer by primary care practitioners - Results from a Europe-wide survey in 20 countries. Cancer Epidemiol. 2020 Apr;65:101698. Epub 2020 Mar 6. 10.1016/j.canep.2020.101698 1877-783X 1877-7821 Cancer Epidemiology http://hdl.handle.net/20.500.13003/11064 32151979 L2005136531 2-s2.0-85081317674 https://hdl.handle.net/20.500.12105/22907 538163000027 Primary healthcare Cancer Rurality Geography Health outcomes General practice Europe Influences of rurality on action to diagnose cancer by primary care practitioners - Results from a Europe-wide survey in 20 countries