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1. Perceptions, attitudes and knowledge of evidence-based medicine in primary care in Spain: a study protocol

Author

Carrillo Ricard, Louro-González Arturo, Marzo-Castillejo Mercè, González Ana, Rotaeche Rafael, Solà Ivan, Alonso-Coello Pablo, Velázquez Paola, García-Velasco Guillermo, and Calderón Carlos

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background The philosophy of evidence-based medicine (EBM) was introduced in the early 90s as a new approach to the practice of medicine, using the best available evidence to make decisions about health care. Despite ongoing controversy, EBM has developed enormously and physicians' attitude towards it is generally positive. Nevertheless, in Spain little is known about this topic. We will therefore undertake a study to explore perceptions, attitudes and knowledge about EBM among primary care physicians. Methods and design A mixed-method study combining qualitative and quantitative designs will target family practitioners in Spain with the objective of evaluating current attitudes and perceptions about evidence-based medicine. The project will consist of two phases: a first phase running focus groups to identify perceptions and attitudes of participants, and a second phase assessing their attitudes and knowledge about EBM by means of a survey. Both phases will explore these issues in three different subgroups: family practitioners, with or without previous formal education in EBM; members of working groups that formulate healthcare recommendations; and physicians in charge of training family practice residents. Additionally, we will undertake a systematic review to identify and synthesize the available evidence on this topic. Discussion The study will identify and gain insight into the perceived problems and barriers to the practice of evidence-based medicine among general practitioners in Spain. The project will also evaluate the main knowledge gaps and training needs, and explore how evidence-based medicine is being taught to family medicine residents, the medical practitioners of the future. Our results will aid researchers and health care planners in developing strategies to improve the practice of evidence-based medicine in our country.

Published
2009
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2. Cabergoline as a Novel Strategy for Post-Pregnancy Breast Cancer Prevention in Mice and Human

Author

García-Sancha*, Natalia, primary, Corchado-Cobos*, Roberto, additional, Blanco-Gómez*, Adrián, additional, Puértolas, Oriol Cunillera, additional, Marzo-Castillejo, Mercè, additional, Castillo-Lluva, Sonia, additional, Alonso-López, Diego, additional, Rivas, Javier De Las, additional, Pozo, Julio, additional, Orfao, Alberto, additional, Valero-Juan, Luis, additional, Patino-Alonso, Carmen, additional, Perera, David, additional, Venkitaraman, Ashok R., additional, Mao, Jian-Hua, additional, Chang, Hang, additional, Mendiburu-Eliçabe, Marina, additional, González-García, Patricia, additional, Caleiras, Eduardo, additional, Peset, Isabel, additional, Cenador, María Begoña García, additional, García-Criado, Francisco Javier, additional, and Pérez-Losada, Jesús, additional

Published
2024
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6. Guía de práctica clínica. Diagnóstico y prevención del cáncer colorrectal. Actualización 2018

Author

Cubiella, Joaquín, Marzo-Castillejo, Mercè, Mascort-Roca, Juan José, Amador-Romero, Francisco Javier, Bellas-Beceiro, Begoña, Clofent-Vilaplana, Joan, Carballal, Sabela, Ferrándiz-Santos, Juan, Gimeno-García, Antonio Z., Jover, Rodrigo, Mangas-Sanjuán, Carolina, Moreira, Leticia, Pellisè, María, Quintero, Enrique, Rodríguez-Camacho, Elena, and Vega-Villaamil, Pablo

Published
2018
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7. What would primary care practitioners do differently after a delayed cancer diagnosis? Learning lessons from their experiences.

Author

Koskela, Tuomas H., Esteva, Magdalena, Mangione, Marcello, Contreras Martos, Sara, Hajdarevic, Senada, Högberg, Cecilia, Marzo-Castillejo, Mercè, Sawicka-Powierza, Jolanta, Siliņa, Vija, Harris, Michael, and Petek, Davorina

Subjects
TUMOR diagnosis, GENERAL practitioners, DELAYED diagnosis, RESEARCH, WORK, QUALITATIVE research, SURVEYS, PSYCHOSOCIAL factors, EXPERIENTIAL learning, THEMATIC analysis
Abstract

Diagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians' (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis. A qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data. A primary care study, with narratives from 159 PCPs in 23 European countries. PCPs' narratives on the question 'If you saw this patient with cancer presenting in the same way today, what would you do differently? The main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and 'I wouldn't do anything differently'. To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients' clinical conditions. Diagnosing cancer in primary care is challenging due to the low incidence of cancer in practice and the multiple confounding factors that are involved in the diagnostic process. The need to think broadly, make improvements in communication and clinical management, and use other available resources were the main themes from Primary Care Physicians' (PCPs') narratives about their learning experiences from missed or late cancer diagnoses. A long-term, holistic and active approach with effective communication, follow-up and continuing re-assessment of the patients' clinical conditions was another theme for making improvements. Some PCPs, on reflection, would not have done anything differently. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study

Author

Hajdarevic, Senada, primary, Högberg, Cecilia, additional, Marzo-Castillejo, Mercè, additional, Siliņa, Vija, additional, Sawicka-Powierza, Jolanta, additional, Esteva, Magadalena, additional, Koskela, Tuomas, additional, Petek, Davorina, additional, Contreras-Martos, Sara, additional, Mangione, Marcello, additional, Ožvačić Adžić, Zlata, additional, Asenova, Radost, additional, Gašparović Babić, Svjetlana, additional, Brekke, Mette, additional, Buczkowski, Krzysztof, additional, Buono, Nicola, additional, Çifçili, Saliha Serap, additional, Dinant, Geert-Jan, additional, Doorn, Babette, additional, Hoffman, Robert D, additional, Kuodza, George, additional, Murchie, Peter, additional, Pilv, Liina, additional, Puia, Aida, additional, Rapalavicius, Aurimas, additional, Smyrnakis, Emmanouil, additional, Weltermann, Birgitta, additional, and Harris, Michael, additional

Published
2023
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10. Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis : a qualitative study

Author

Hajdarevic, Senada, Högberg, Cecilia, Marzo-Castillejo, Mercè, Siliņa, Vija, Sawicka-Powierza, Jolanta, Esteva, Magadalena, Koskela, Tuomas, Petek, Davorina, Contreras-Martos, Sara, Mangione, Marcello, Ožvačić Adžić, Zlata, Asenova, Radost, Gašparović Babić, Svjetlana, Brekke, Mette, Buczkowski, Krzysztof, Buono, Nicola, Çifçili, Saliha Serap, Dinant, Geert-Jan, Doorn, Babette, Hoffman, Robert D., Kuodza, George, Murchie, Peter, Pilv, Liina, Puia, Aida, Rapalavicius, Aurimas, Smyrnakis, Emmanouil, Weltermann, Birgitta, Harris, Michael, Hajdarevic, Senada, Högberg, Cecilia, Marzo-Castillejo, Mercè, Siliņa, Vija, Sawicka-Powierza, Jolanta, Esteva, Magadalena, Koskela, Tuomas, Petek, Davorina, Contreras-Martos, Sara, Mangione, Marcello, Ožvačić Adžić, Zlata, Asenova, Radost, Gašparović Babić, Svjetlana, Brekke, Mette, Buczkowski, Krzysztof, Buono, Nicola, Çifçili, Saliha Serap, Dinant, Geert-Jan, Doorn, Babette, Hoffman, Robert D., Kuodza, George, Murchie, Peter, Pilv, Liina, Puia, Aida, Rapalavicius, Aurimas, Smyrnakis, Emmanouil, Weltermann, Birgitta, and Harris, Michael

Abstract

Background: While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. Aim: To explore European PCPs’ experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. Design & setting: A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. Method: Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. Results: A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients’ descriptions did not suggest cancer; distracting factors reduced PCPs’ cancer suspicions; patients’ hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. Conclusion: The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The ‘Swiss cheese’ model of accident causation showed how the themes related to each other.

Published
2023
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11. What would primary care practitioners do differently after a delayed cancer diagnosis? : Learning lessons from their experiences

Author

Koskela, Tuomas H., Esteva, Magdalena, Mangione, Marcello, Contreras Martos, Sara, Hajdarevic, Senada, Högberg, Cecilia, Marzo-Castillejo, Mercè, Sawicka-Powierza, Jolanta, Siliņa, Vija, Harris, Michael, Petek, Davorina, Koskela, Tuomas H., Esteva, Magdalena, Mangione, Marcello, Contreras Martos, Sara, Hajdarevic, Senada, Högberg, Cecilia, Marzo-Castillejo, Mercè, Sawicka-Powierza, Jolanta, Siliņa, Vija, Harris, Michael, and Petek, Davorina

Abstract

Objective: Diagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians’ (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis. Design: A qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data. Setting and subjects: A primary care study, with narratives from 159 PCPs in 23 European countries. Main outcome measures: PCPs’ narratives on the question ‘If you saw this patient with cancer presenting in the same way today, what would you do differently? Results: The main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and ‘I wouldn’t do anything differently’. Conclusion (Implications): To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients’ clinical conditions.

Published
2023
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15. Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? A qualitative study

Author

Hajdarevic, Senada, Högberg, Cecilia, Marzo-Castillejo, Mercè, Siliņa, Vija, Sawicka-Powierza, Jolanta, Esteva, Magadalena, Koskela, Tuomas, Petek, Davorina, Contreras-Martos, Sara, Mangione, Marcello, Ožvačić Adžić, Zlata, Asenova, Radost, Gašparović Babić, Svjetlana, Brekke, Mette, Buczkowski, Krzysztof, Buono, Nicola, Çifçili Saliha, Serap, Dinant, Geert-Jan, Doorn, Babette, Hoffman, Robert D, Kuodza, George, Murchie, Peter, Pilv, Liina, Puia, Aida, Rapalavicius, Aurimas, Smyrnakis, Emmanouil, Weltermann, Birgitta, and Harris, Michael

Subjects
360 Social problems & social services, 360 Soziale Probleme, Sozialdienste, 610 Medicine & health, 610 Medizin und Gesundheit
Abstract

BACKGROUND While Primary Care Physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. AIM This study explores European PCPs' experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. DESIGN & SETTING A multicentre European qualitative study, based on an online survey with open-ended questions asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. METHOD Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. RESULTS A total of 158 PCPs completed the questionnaire. The main themes were: where patients' descriptions did not suggest cancer; when distracting factors reduced PCPs' suspicions of cancer; when patients' hesitancy delayed the diagnosis; where system factors hampered the diagnostic process; when PCPs felt that they had made a mistake; and inadequate communication. CONCLUSION The study identified six overarching themes which need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The 'Swiss cheese' model of accident causation shows how the themes relate to each other.

Published
2023
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16. European Code Against Cancer : what does the Spanish population know and think about its recommendations?

Author

CECC-AP study, Pérula-de-Torres, Luis Ángel, Marzo-Castillejo, Mercè, Ranchal-Sánchez, Antonio, Bartolomé-Moreno, Cruz, Parras-Rejano, Juan Manuel, Bellas-Beceiro, Begoña, Vela-Vallespin, Carmen, Nuin-Villanueva, Maria Angeles, Melús-Palazón, Elena, Vilarrubí-Estrella, Mercè, Muro, María Martin-Rabadán, Domingez, Pilar Martin-Carrillo, and Magallón-Botaya, Rosa

Published
2015

19. Cancer diagnosis in primary care after second pandemic year in Catalonia: a time-series analysis of primary care electronic health records covering about 5 million people

Author

Mora, Núria, primary, Guiriguet, Carolina, additional, Cantenys, Roser, additional, Méndez-Boo, Leonardo, additional, Marzo-Castillejo, Mercè, additional, Benítez, Mència, additional, Fina, Francesc, additional, Fàbregas, Mireia, additional, Hermosilla, Eduardo, additional, Mercadé, Albert, additional, Medina, Manuel, additional, and Coma, Ermengol, additional

Published
2022
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21. Evaluating the controlled reopening of nightlife during the COVID-19 pandemic: a matched cohort study in Sitges, Spain, in May 2021 (Reobrim Sitges)

Author

Cunillera Puértolas, Oriol, primary, Contreras-Martos, Sara, additional, Marzo-Castillejo, Mercè, additional, López Gallegos, Darío, additional, Acedo Anta, Mateo, additional, Almeda Ortega, Jesús, additional, Colom, Joan, additional, Basora, Josep, additional, and Salvador-Gonzalez, Betlem, additional

Published
2022
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23. Women's experiences along the ovarian cancer diagnostic pathway in Catalonia: A qualitative study.

Author

Vela‐Vallespín, Carmen, Medina‐Perucha, Laura, Jacques‐Aviñó, Constanza, Codern‐Bové, Núria, Harris, Meggan, Borras, Josep M., and Marzo‐Castillejo, Mercè

Subjects
DELAYED diagnosis, OVARIAN tumors, CATALANS, HEALTH services accessibility, RESEARCH methodology, WOMEN, INTERVIEWING, CANCER patients, PATIENTS' attitudes, QUALITATIVE research, PHENOMENOLOGY, HEALTH literacy, RESEARCH funding, SOUND recordings, DECISION making, HEALTH insurance, JUDGMENT sampling, THEMATIC analysis, CONTENT analysis, DATA analysis software, ALTERNATIVE medicine
Abstract

Background: Early detection of symptoms and prompt diagnosis of ovarian cancer are considered important avenues for improving patient experiences and outcomes. Methods: This qualitative study used a phenomenological approach to perform patient interviews, collecting individual accounts of the prediagnostic phase in women diagnosed and treated for ovarian cancer in 2016–2017. Purposive sampling was used to obtain a diverse sample of 24 participants, while thematic content analysis was used to extract themes and subthemes from interview data. Results: Three themes and nine subthemes were identified. The first theme was women's delay in recognizing symptoms and seeking care, with subthemes on the lack of knowledge about early signs of ovarian cancer, gender‐related barriers and false reassurance from negative test results. A second theme was missed opportunities during healthcare encounters, due to misattribution of women's symptoms by their physicians, underestimation of symptom severity and need for mediation and inadequate tests and/or false negative results. Finally, interviews highlighted the use of resources and alternative healthcare pathways, including complementary/alternative medicines, access to private health care and women's capacity for action and decision‐making (agency) about their health. Conclusion: Delayed diagnosis of ovarian cancer is rooted in both individual factors (lack of health literacy, reluctance to seek care) and systemic issues (missed opportunities in healthcare encounters, access to timely specialist care). Further research is needed to investigate the extent to which traditional gender roles and socioeconomic inequalities condition women's ability to manage their own health and to interact with health professionals and the health system. Patient and Public Contribution: In addition to the patient participation during the interviews, one author was a representative of a patient association. [ABSTRACT FROM AUTHOR]

Published
2023
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24. Cancer diagnosis in primary care after second pandemic year in Catalonia: a time-series analysis of primary care electronic health records covering about 5 million people.

Author

Mora, Núria, Guiriguet, Carolina, Cantenys, Roser, Méndez-Boo, Leonardo, Marzo-Castillejo, Mercè, Benítez, Mència, Fina, Francesc, Fàbregas, Mireia, Hermosilla, Eduardo, Mercadé, Albert, Medina, Manuel, and Coma, Ermengol

Subjects
ELECTRONIC health records, CANCER diagnosis, TIME series analysis, SKIN cancer, PRIMARY care, COVID-19 pandemic
Abstract

Background During the COVID-19 pandemic, the incidence of chronic disease had drastically been reduced due to health care interruptions. The aim of this study is to analyse cancer diagnosis during the last 2 years of the COVID-19 pandemic. Methods Time-series study of cancer diagnoses recorded in primary care settings, using data from the primary care electronic health records from January 2014 to December 2021. We obtained the expected monthly rate per 100,000 inhabitants using a time regression adjusted by trend and seasonality. We additionally compared rates of cancer diagnoses in 2019 with those of 2020 and 2021 using the t -test. We performed the analysis globally, by sex and by type of cancer. Results In 2020, the rate of cancer diagnoses had reduced by −21% compared to 2019 (P < 0.05). Greater reductions were observed during the lockdown in early 2020 (>40%) and with some types of cancers, especially prostate and skin cancers (−29.6% and −26.9%, respectively, P < 0.05). Lung cancers presented statistically non-significant reductions in both years. Cancer diagnosis returned to expected around March 2021, and the rate in 2021 was similar to that of 2019 (overall difference of 0.21%, P = 0.967). However, an 11% reduction was still found when comparing the pandemic months of 2020–2021 with pre-pandemic months. Conclusions Although primary care cancer diagnoses in 2021 have returned to pre-pandemic levels, missing diagnoses during the last 2 years have not been fully recovered. [ABSTRACT FROM AUTHOR]

Published
2023
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25. Cancer diagnosis in primary care after second pandemic year in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

Author

Mora, Núria, primary, Guiriguet, Carolina, additional, Cantenys, Roser, additional, Méndez-Boo, Leonardo, additional, Marzo-Castillejo, Mercè, additional, Benítez, Mència, additional, Fina, Francesc, additional, Fàbregas, Mireia, additional, Hermosilla, Eduardo, additional, Mercadé, Albert, additional, Medina, Manuel, additional, and Coma, Ermengol, additional

Published
2022
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26. ORENAS

Author

Tzanis, George, Harris, Michael, Brekke, Mette, Marzo-Castillejo, Mercè, Cifcili, Saliha Serap, Wawrzynek, Wojciech, Flamm, Maria, Buono, Nicola, Márkus, Bernadett, Zacay, Galia, Skuja, Ilze, Adzic, Zlata Ozvacic, Iacob, Mihai, Asenova, Radost, Petek, Davorina, Buczkowski, Krzysztof, Curtis, Pamela, Pilv-Toom, Liina, Hoffman, Robert, and Smyrnakis, Emmanouil

Subjects
Delphi method, Primary Health Care, cancer, empowerment, general practitioners
Abstract

Background: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. Aim: To identify the factors that affect European GPs' empowerment in making an early diagnosis of cancer. Methods: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale.The final list of statements indicated those that were considered by consensus to be the most relevant. Results: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs' working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. Conclusion: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.

Published
2022

27. What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study

Author

Tzanis, George, Harris, Michael, Brekke, Mette, Marzo-Castillejo, Mercè, Cifcili, Saliha Serap, Wawrzynek, Wojciech, Flamm, Maria, Buono, Nicola, Márkus, Bernadett, Zacay, Galia, Skuja, Ilze, Adzic, Zlata Ozvacic, Iacob, Mihai, Asenova, Radost, Petek, Davorina, Buczkowski, Krzysztof, Curtis, Pamela, Pilv-Toom, Liina, Hoffman, Robert, Smyrnakis, Emmanouil, and Tzanis G., Harris M., Brekke M., Marzo-Castillejo M., ÇİFÇİLİ S. S. , Wawrzynek W., Flamm M., Buono N., Márkus B., Zacay G., et al.

Subjects
Social Sciences and Humanities, Delphi Technique, Social Sciences (SOC), Family Medicine, SOCIAL SCIENCES, GENERAL, SAĞLIK BAKIM BİLİMLERİ VE HİZMETLERİ, Delphi method, 610 Medicine & health, Aile Hekimliği, Sağlık Bilimleri, Secondary Care, Clinical Medicine (MED), Bakım Planlaması, Sociology, 360 Social problems & social services, Primary Health Care, cancer, empowerment, general practitioners, Neoplasms, Health Sciences, Humans, Sosyal ve Beşeri Bilimler, Klinik Tıp (MED), Sosyoloji, Care Planning, Early Detection of Cancer, Halk, Çevre ve İş Sağlığı, PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH, Internal Medicine Sciences, Klinik Tıp, 360 Soziale Probleme, Sozialdienste, Public Health, Environmental and Occupational Health, Dahili Tıp Bilimleri, Sosyal Bilimler Genel, CLINICAL MEDICINE, KAMU, ÇEVRE VE İŞ SAĞLIĞI, HEALTH CARE SCIENCES & SERVICES, Tıp, Medicine, Sosyal Bilimler (SOC), 610 Medizin und Gesundheit
Abstract

Background: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. Aim: To identify the factors that affect European GPs’ empowerment in making an early diagnosis of cancer. Methods: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale. The final list of statements indicated those that were considered by consensus to be the most relevant. Results: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs’ working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. Conclusion: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.

Published
2022

31. Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

Author

Coma, Ermengol, primary, Guiriguet, Carolina, additional, Mora, Nuria, additional, Marzo-Castillejo, Mercè, additional, Benítez, Mencia, additional, Méndez-Boo, Leonardo, additional, Fina, Francesc, additional, Fàbregas, Mireia, additional, Mercadé, Albert, additional, and Medina, Manuel, additional

Published
2021
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32. The impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: A time-series analysis of primary care electronic health records covering about 5 million people

Author

Coma, Ermengol, primary, Guiriguet, Carolina, additional, Mora, Núria, additional, Marzo-Castillejo, Mercè, additional, Benítez, Mència, additional, Méndez-Boo, Leonardo, additional, Fina, Francesc, additional, Fàbregas, Mireia, additional, Mercadé, Albert, additional, and Medina, Manuel, additional

Published
2020
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34. Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries

Author

Harris, Michael, primary, Brekke, Mette, additional, Dinant, Geert-Jan, additional, Esteva, Magdalena, additional, Hoffman, Robert, additional, Marzo-Castillejo, Mercè, additional, Murchie, Peter, additional, Neves, Ana Luísa, additional, Smyrnakis, Emmanouil, additional, Vedsted, Peter, additional, Aubin-Auger, Isabelle, additional, Azuri, Joseph, additional, Buczkowski, Krzysztof, additional, Buono, Nicola, additional, Foreva, Gergana, additional, Babić, Svjetlana Gašparović, additional, Jacob, Eva, additional, Koskela, Tuomas, additional, Petek, Davorina, additional, Šter, Marija Petek, additional, Puia, Aida, additional, Sawicka-Powierza, Jolanta, additional, Streit, Sven, additional, Thulesius, Hans, additional, Weltermann, Birgitta, additional, and Taylor, Gordon, additional

Published
2020
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35. How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis

Author

Harris, Michael, primary, Thulesius, Hans, additional, Neves, Ana Luísa, additional, Harker, Sophie, additional, Koskela, Tuomas, additional, Petek, Davorina, additional, Hoffman, Robert, additional, Brekke, Mette, additional, Buczkowski, Krzysztof, additional, Buono, Nicola, additional, Costiug, Emiliana, additional, Dinant, Geert-Jan, additional, Foreva, Gergana, additional, Jakob, Eva, additional, Marzo-Castillejo, Mercè, additional, Murchie, Peter, additional, Sawicka-Powierza, Jolanta, additional, Schneider, Antonius, additional, Smyrnakis, Emmanouil, additional, Streit, Sven, additional, Taylor, Gordon, additional, Vedsted, Peter, additional, Weltermann, Birgitta, additional, and Esteva, Magdalena, additional

Published
2019
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36. Endoscopic surveillance after colonic polyps and colorrectal cancer resection. 2018 update

Author

Mangas-Sanjuan, Carolina, primary, Jover, Rodrigo, additional, Cubiella, Joaquín, additional, Marzo-Castillejo, Mercè, additional, Balaguer, Francesc, additional, Bessa, Xavier, additional, Bujanda, Luis, additional, Bustamante, Marco, additional, Castells, Antoni, additional, Diaz-Tasende, José, additional, Díez-Redondo, Pilar, additional, Herráiz, Maite, additional, Mascort-Roca, Juan José, additional, Pellisé, María, additional, and Quintero, Enrique, additional

Published
2019
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38. Clinical practice guideline. Diagnosis and prevention of colorectal cancer. 2018 Update

Author

Cubiella, Joaquín, primary, Marzo-Castillejo, Mercè, additional, Mascort-Roca, Juan José, additional, Amador-Romero, Francisco Javier, additional, Bellas-Beceiro, Begoña, additional, Clofent-Vilaplana, Joan, additional, Carballal, Sabela, additional, Ferrándiz-Santos, Juan, additional, Gimeno-García, Antonio Z., additional, Jover, Rodrigo, additional, Mangas-Sanjuán, Carolina, additional, Moreira, Leticia, additional, Pellisè, María, additional, Quintero, Enrique, additional, Rodríguez-Camacho, Elena, additional, and Vega-Villaamil, Pablo, additional

Published
2018
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39. Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion : a European cross-sectional survey.

Author

Harris, Michael, Vedsted, Peter, Esteva, Magdalena, Murchie, Peter, Aubin-Auger, Isabelle, Azuri, Joseph, Brekke, Mette, Buczkowski, Krzysztof, Buono, Nicola, Costiug, Emiliana, Dinant, Geert-Jan, Foreva, Gergana, Gašparović Babić, Svjetlana, Hoffman, Robert, Jakob, Eva, Koskela, Tuomas H, Marzo-Castillejo, Mercè, Neves, Ana Luísa, Petek, Davorina, Petek Ster, Marija, Sawicka-Powierza, Jolanta, Schneider, Antonius, Smyrnakis, Emmanouil, Streit, Sven, Thulesius, Hans, Weltermann, Birgitta, Taylor, Gordon, Harris, Michael, Vedsted, Peter, Esteva, Magdalena, Murchie, Peter, Aubin-Auger, Isabelle, Azuri, Joseph, Brekke, Mette, Buczkowski, Krzysztof, Buono, Nicola, Costiug, Emiliana, Dinant, Geert-Jan, Foreva, Gergana, Gašparović Babić, Svjetlana, Hoffman, Robert, Jakob, Eva, Koskela, Tuomas H, Marzo-Castillejo, Mercè, Neves, Ana Luísa, Petek, Davorina, Petek Ster, Marija, Sawicka-Powierza, Jolanta, Schneider, Antonius, Smyrnakis, Emmanouil, Streit, Sven, Thulesius, Hans, Weltermann, Birgitta, and Taylor, Gordon

Abstract

OBJECTIVES: Cancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners' (PCPs') referral decisions is lacking.This study analyses health system factors potentially influencing PCPs' referral decision-making when consulting with patients who may have cancer, and how these vary between European countries. DESIGN: Based on a content-validity consensus, a list of 45 items relating to a PCP's decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs' referral decision-making. SETTING: A primary care study; 25 participating centres in 20 European countries. PARTICIPANTS: 1830 PCPs completed the survey. The median response rate for participating centres was 20.7%. OUTCOME MEASURES: The factors derived from items related to PCPs' referral decision-making. Mean factor scores were produced for each country, allowing comparisons. RESULTS: Factor analysis identified five underlying factors: PCPs' ability to refer; degree of direct patient access to secondary care; PCPs' perceptions of being under pressure; expectations of PCPs' role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses. CONCLUSIONS: Five healthcare system factors influencing PCPs' referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of h

Published
2018
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40. Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross-sectional survey

Author

Harris, Michael, primary, Vedsted, Peter, additional, Esteva, Magdalena, additional, Murchie, Peter, additional, Aubin-Auger, Isabelle, additional, Azuri, Joseph, additional, Brekke, Mette, additional, Buczkowski, Krzysztof, additional, Buono, Nicola, additional, Costiug, Emiliana, additional, Dinant, Geert-Jan, additional, Foreva, Gergana, additional, Gašparović Babić, Svjetlana, additional, Hoffman, Robert, additional, Jakob, Eva, additional, Koskela, Tuomas H, additional, Marzo-Castillejo, Mercè, additional, Neves, Ana Luísa, additional, Petek, Davorina, additional, Petek Ster, Marija, additional, Sawicka-Powierza, Jolanta, additional, Schneider, Antonius, additional, Smyrnakis, Emmanouil, additional, Streit, Sven, additional, Thulesius, Hans, additional, Weltermann, Birgitta, additional, and Taylor, Gordon, additional

Published
2018
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42. How the probability of presentation to a primary care clinician correlates with cancer survival rates : a European survey using vignettes.

Author

Harris, Michael, Frey, Peter, Esteva, Magdalena, Gašparović Babić, Svjetlana, Marzo-Castillejo, Mercè, Petek, Davorina, Petek Ster, Marija, Thulesius, Hans, Harris, Michael, Frey, Peter, Esteva, Magdalena, Gašparović Babić, Svjetlana, Marzo-Castillejo, Mercè, Petek, Davorina, Petek Ster, Marija, and Thulesius, Hans

Abstract

OBJECTIVE: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. DESIGN: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. SETTING: A total of 14 countries. SUBJECTS: Consensus groups of PCPs. MAIN OUTCOME MEASURES: Probability of initial presentation to a PCP for four clinical vignettes. RESULTS: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r = -0.16, 95% CI -0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = -0.57, 95% CI -0.83 to -0.12; ovary: r = -0.13, 95% CI -0.57 to 0.38; breast r = 0.14, 95% CI -0.36 to 0.58; bowel: r = 0.20, 95% CI -0.31 to 0.62). CONCLUSIONS: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a "PCP-as-gatekeeper" system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival. KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of i

Published
2017
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48. Improvement of functional constipation with kiwifruit intake in a Mediterranean patient population: an open, non-randomized pilot study

Author

Cunillera, Oriol, Almeda, Jesús, Mascort, Juan José, Basora, Josep, and Marzo-Castillejo, Mercè

Subjects
Estreñimiento funcional, Promoción de la Salud, Edad avanzada, Anciano, Health Promotion, Kiwi, Elderly, Fruta, Fruit, Estreñimiento, Kiwifruit, Constipation, Functional constipation, Aged
Abstract

Introduction: Kiwifruit consumption has shown to improve functional constipation in healthy elderly population, according to studies in New Zealand and China. The aim of this study was to evaluate the effect of kiwifruit intake on functional constipation in a Mediterranean patient population characterized by its distinctive nutritional habits. Material and Methods: An open, non-controlled and non-randomized longitudinal study was conducted in 46 patients with constipation (Rome III criteria). Patients monitored for five weeks: weeks 1 and 2 no kiwifruit and weeks 3-5 three kiwifruit per day (Green kiwifruit, Actinidia deliciosa var Hayward). Bristol Scale, volume of stools, and ease of defecation was self- reported daily. The evolution of the categorical variables was tested using the Bhapkar test; functional data methodology was used for continuous variables, and Generalized Estimating Equation (GEE) models were adjusted. Results: The percentage of patients with ≥3 stools per week increased from 82.61% (95% CI: 69-91.2) at week 1 to 97.78% (95% CI: 87.4-99.9) at week 2 of kiwifruit intake, with 76.09% (95% CI: 61.9-86.2) responding during the first week. The reporting of stable ideal stools increased from 17.39% (95% CI: 8.8-31) at week 2 to 33.33% (95% CI: 21.3-48) at week 5. According to GEE models, the number of depositions increased significantly (p-values

Published
2015

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