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Implementing a QCancer risk tool into general practice consultations: an exploratory study using simulated consultations with Australian general practitioners.

Chiang PP, Glance D, Walker J, Walter FM, Emery JD - Br. J. Cancer (2015)

Bottom Line: The risk tool was perceived as being potentially useful for patients with complex histories.Variable interpretation of symptoms meant that there was significant variation in risk assessment.These relate not only to the design and integration of the tool but also to variation in interpretation of clinical histories, and therefore variable risk outputs and strong beliefs in personal clinical intuition.

View Article: PubMed Central - PubMed

Affiliation: General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia.

ABSTRACT

Background: Reducing diagnostic delays in primary care by improving the assessment of symptoms associated with cancer could have significant impacts on cancer outcomes. Symptom risk assessment tools could improve the diagnostic assessment of patients with symptoms suggestive of cancer in primary care. We aimed to explore the use of a cancer risk tool, which implements the QCancer model, in consultations and its potential impact on clinical decision making.

Methods: We implemented an exploratory 'action design' method with 15 general practitioners (GPs) from Victoria, Australia. General practitioners applied the risk tool in simulated consultations, conducted semi-structured interviews based on the normalisation process theory and explored issues relating to implementation of the tool.

Results: The risk tool was perceived as being potentially useful for patients with complex histories. More experienced GPs were distrustful of the risk output, especially when it conflicted with their clinical judgement. Variable interpretation of symptoms meant that there was significant variation in risk assessment. When a risk output was high, GPs were confronted with numerical risk outputs creating challenges in consultation.

Conclusions: Significant barriers to implementing electronic cancer risk assessment tools in consultation could limit their uptake. These relate not only to the design and integration of the tool but also to variation in interpretation of clinical histories, and therefore variable risk outputs and strong beliefs in personal clinical intuition.

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Related in: MedlinePlus

Screenshots of QCancer risk tool.
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fig1: Screenshots of QCancer risk tool.

Mentions: For this study the QCancer model was implemented into a specific web-based version, with the interface designed as a simple, single browser page (Figure 1). The source code for the QCancer risk model was provided by ClinRisk Ltd (Leeds, UK) (personal communication J Hippisley-Cox). In addition to providing risk estimates for each cancer based on the QCancer model, our tool gave summary information on best practice diagnostic pathways for each cancer based on Australian guidelines (2005) and Cancer Australia (2012).


Implementing a QCancer risk tool into general practice consultations: an exploratory study using simulated consultations with Australian general practitioners.

Chiang PP, Glance D, Walker J, Walter FM, Emery JD - Br. J. Cancer (2015)

Screenshots of QCancer risk tool.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385980&req=5

fig1: Screenshots of QCancer risk tool.
Mentions: For this study the QCancer model was implemented into a specific web-based version, with the interface designed as a simple, single browser page (Figure 1). The source code for the QCancer risk model was provided by ClinRisk Ltd (Leeds, UK) (personal communication J Hippisley-Cox). In addition to providing risk estimates for each cancer based on the QCancer model, our tool gave summary information on best practice diagnostic pathways for each cancer based on Australian guidelines (2005) and Cancer Australia (2012).

Bottom Line: The risk tool was perceived as being potentially useful for patients with complex histories.Variable interpretation of symptoms meant that there was significant variation in risk assessment.These relate not only to the design and integration of the tool but also to variation in interpretation of clinical histories, and therefore variable risk outputs and strong beliefs in personal clinical intuition.

View Article: PubMed Central - PubMed

Affiliation: General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia.

ABSTRACT

Background: Reducing diagnostic delays in primary care by improving the assessment of symptoms associated with cancer could have significant impacts on cancer outcomes. Symptom risk assessment tools could improve the diagnostic assessment of patients with symptoms suggestive of cancer in primary care. We aimed to explore the use of a cancer risk tool, which implements the QCancer model, in consultations and its potential impact on clinical decision making.

Methods: We implemented an exploratory 'action design' method with 15 general practitioners (GPs) from Victoria, Australia. General practitioners applied the risk tool in simulated consultations, conducted semi-structured interviews based on the normalisation process theory and explored issues relating to implementation of the tool.

Results: The risk tool was perceived as being potentially useful for patients with complex histories. More experienced GPs were distrustful of the risk output, especially when it conflicted with their clinical judgement. Variable interpretation of symptoms meant that there was significant variation in risk assessment. When a risk output was high, GPs were confronted with numerical risk outputs creating challenges in consultation.

Conclusions: Significant barriers to implementing electronic cancer risk assessment tools in consultation could limit their uptake. These relate not only to the design and integration of the tool but also to variation in interpretation of clinical histories, and therefore variable risk outputs and strong beliefs in personal clinical intuition.

Show MeSH
Related in: MedlinePlus