General practitioners’ clinical decision-making in patients that could have cancer: a vignette study comparing the Baltic states with four Nordic countries

OBJECTIVE: Relative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics. DESIGN: A survey of GPs using clinical vignettes. SETTING: General Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden. SUBJECTS: General Practitioners. OUTCOME MEASURES: A regional comparison of GPs' stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%). Neither GP sex nor practice location within a country showed a significant association with these measures. CONCLUSION: While relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs' reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences.