Figure 1
Number of participants and response rates in each of the five participating countries_
| Bulgaria | Croatia | Greece | Romania | Slovenia | |
|---|---|---|---|---|---|
| Number of respondents | 59 | 67 | 68 | 177 | 104 |
| Number invited | 90 | 292 | 318 | Unknown | 352 |
| Response rate (%) | 65.6 | 22.9 | 21.4 | Unknown | 29.5 |
Effects of PCP and practice demographics, system factors, availability of relevant investigations and country on (a) PCPs’ likelihood of scheduling an investigation and (b) likelihood of referral patients to a specialist, for a patient with symptoms that could be due to lung cancer_
| Statement | a) Effects on PCPs’ likelihood of organising an investigation | b) Effects on PCPs’ likelihood of referral to a specialist | ||||
|---|---|---|---|---|---|---|
| Exp(B) | 95% CI | P value | Exp(B) | 95% CI | P value | |
| Sex (Male) | 0.912 | 0.478-1.742 | 0.781 | 0.806 | 0.406-1.599 | 0.536 |
| Type of practice (Urban) | 0.899 | 0.515 | ||||
| Rural | 0.823 | 0.424-1.596 | 0.564 | 1.555 | 0.802-3.015 | 0.191 |
| Island | 1.312 | 0.264-6.521 | 0.740 | 2.198 | 0.422-11.459 | 0.350 |
| Mixed | 1.028 | 0.486-2.174 | 0.943 | 1.101 | 0.470-2.580 | 0.824 |
| Years since graduation (Less than 10) | 0.474 | 0.975 | ||||
| 10 to 19 | 0.948 | 0.354-2.541 | 0.916 | 1.259 | 0.438-3.616 | 0.669 |
| 20 to 29 | 0.697 | 0.267-1.818 | 0.461 | 1.105 | 0.398-3.063 | 0.848 |
| 30 to 39 | 1.465 | 0.505-4.249 | 0.482 | 1.212 | 0.405-3.629 | 0.732 |
| 40 or more | 1.117 | 0.201-6.216 | 0.900 | 0.784 | 0.129-4.776 | 0.792 |
| ‘Common presentations are | 0.731 | 0.662 | ||||
| covered by local or national | ||||||
| guidelines’ (Strongly disagree) | ||||||
| Disagree | 2.017 | 0.490-8.296 | 0.331 | 1.000 | 0.254-3.940 | 1.000 |
| Neither agree nor disagree | 1.572 | 0.416-5.936 | 0.504 | 1.159 | 0.316-4.246 | 0.824 |
| Agree | 2.162 | 0.573-8.162 | 0.255 | 1.527 | 0.423-5.517 | 0.518 |
| Strongly agree | 1.548 | 0.317-7.547 | 0.589 | 0.789 | 0.152-4.105 | 0.778 |
| ‘We have access to a fast-track specialist | 0.324 | 0.318 | ||||
| appointment system’ (Strongly disagree) | ||||||
| Disagree | 0.904 | 0.371-2.202 | 0.825 | 0.647 | 0.266-1.577 | 0.338 |
| Neither agree nor disagree | 1.960 | 0.655-5.862 | 0.229 | 1.015 | 0.366-2.809 | 0.978 |
| Agree | 0.840 | 0.329-2.145 | 0.716 | 0.833 | 0.320-2.169 | 0.708 |
| Strongly agree | 1.885 | 0.465-7.640 | 0.375 | 2.130 | 0.572-7.931 | 0.259 |
| ‘Patients can self-refer to | 0.263 | 0.910 | ||||
| specialists’ (Strongly disagree) | ||||||
| Disagree | 1.407 | 0.755-2.621 | 0.283 | 1.150 | 0.588-2.247 | 0.683 |
| Neither agree nor disagree | 0.941 | 0.377-2.348 | 0.896 | 1.190 | 0.470-3.013 | 0.713 |
| Agree | 3.676 | 0.979-13.807 | 0.054 | 0.868 | 0.341-2.212 | 0.768 |
| Strongly agree | 2.059 | 0.474-8.952 | 0.335 | 1.696 | 0.414-6.955 | 0.463 |
| Number of relevant investigations | 0.376 | 0.257 | ||||
| available (None) | ||||||
| One | 0.250 | 0.024-2.622 | 0.248 | 0.160 | 0.028-0.907 | 0.038 |
| Two | 0.365 | 0.043-3.104 | 0.356 | 0.358 | 0.091-1.404 | 0.141 |
| Three | 0.763 | 0.049-11.952 | 0.847 | 0.552 | 0.065-4.654 | 0.585 |
| Four | 0.552 | 0.060-5.069 | 0.599 | 0.198 | 0.042-0.929 | 0.040 |
| Five | 0.257 | 0.027-2.400 | 0.233 | 0.251 | 0.049-1.285 | 0.097 |
| Country (Bulgaria) | <.001 | <0.001 | ||||
| Croatia | 0.188 | 0.062-0.572 | 0.003 | 0.286 | 0.098-0.840 | 0.023 |
| Greece | 0.657 | 0.179-2.414 | 0.527 | 0.160 | 0.042-0.611 | 0.007 |
| Romania | 1.600 | 0.544-4.705 | 0.393 | 3.473 | 1.544-7.813 | 0.003 |
| Slovenia | 0.210 | 0.063-0.694 | 0.011 | 0.345 | 0.115-1.033 | 0.057 |
| Constant | 7.205 | 0.145 | 1.349 | 0.781 | ||
PCPs’ levels of agreement with statements on health system factors that could influence the timeliness of cancer diagnosis_
| Statement | Mean Likert scores (SD)1 | Significance | ||||
|---|---|---|---|---|---|---|
| Bulgaria | Croatia | Greece | Romania | Slovenia (P value) | ||
| ‘Common presentations and advice to which to refer are covered by local or national guidelines’ | 2.76 (1.01) | 3.22 (0.98) | 3.59 (1.01) | 3.37 (1.00) | 3.73 (0.84) | <0.001 |
| ‘We have access to a fast- track specialist appointment system if cancer is suspected’ | 2.71 (1.19) | 3.22 (1.17) | 2.45 (1.11) | 2.58 (1.08) | 3.22 (1.22) | <0.001 |
| ‘Patients can self-refer to specialists, so GPs don’t need to act as gatekeepers.’ | 2.39 (1.04) | 2.04 (1.02) | 2.58 (1.30) | 2.38 (1.15) | 1.55 (0.85) | <0.001 |
Participants’ demographic and practice information for each of the five participating countries_
| Bulgaria n (%) | Croatia n (%) | Greece n (%) | Romania n (%) | Slovenia n (%) | ||
|---|---|---|---|---|---|---|
| Sex | Male | 13 (22.0) | 12 (17.9) | 34 (50.0) | 21 (11.9) | 25 (24.0) |
| Female | 44 (74.6) | 54 (80.6) | 34 (50.0) | 154 (87.0) | 78 (75.0) | |
| Not given | 2 (3.4) | 1 (1.5) | 0 (0.0) | 2 (1.2) | 1 (1.0) | |
| Years since | Less than 10 | 8 (13.6) | 11 (16.4) | 0 (0.0) | 8 (4.5) | 17 (16.3) |
| graduation | 10 to 19 | 11 (18.6) | 10 (14.9) | 38 (55.9) | 42 (23.7) | 34 (32.7) |
| 20 to 29 | 23 (39.0) | 22 (32.8) | 25 (36.8) | 75 (42.4) | 32 (30.8) | |
| 30 to 39 | 11 (18.6) | 21 (31.3) | 5 (7.4) | 50 (28.2) | 16 (15.4) | |
| 40 or more | 5 (8.5) | 1 (1.5) | 0 (0.0) | 0 (0.0) | 5 (4.8) | |
| Not given | 1 (1.7) | 2 (3.0) | 0 (0.0) | 2 (1.1) | 0 (0.0) | |
| Type of practice | Urban | 44 (74.6) | 31 (46.3) | 20 (29.4) | 108 (61.0) | 44 (42.3) |
| Rural | 5 (8.5) | 23 (34.3) | 34 (50.0) | 60 (33.9) | 31 (29.8) | |
| Mixed | 9 (15.3) | 13 (19.4) | 14 (20.6) | 7 (4.0) | 29 (27.9) | |
| Not given | 1 (1.7) | 0 (0.0) | 0 (0.0) | 2 (1.1) | 0 (0.0) | |
| Number of PCPs | 1 | 32 (54.2) | 33 (49.3) | 24 (35.3) | 64 (36.2) | 7 (6.7) |
| in the practice | 2 | 8 (13.6) | 9 (19.4) | 8 (11.8) | 33 (18.6) | 10 (9.6) |
| 3 | 8 (13.6) | 6 (9.0) | 3 (4.4) | 17 (9.6) | 14 (13.5) | |
| 4-5 | 1 (1.7) | 6 (9.0) | 11 (16.2) | 20 (11.3) | 10 (9.6) | |
| 6-7 | 1 (1.7) | 6 (9.0) | 6 (8.8) | 9 (5.1) | 12 (11.5) | |
| 8-9 | 1 (1.7) | 5 (7.5) | 1 (1.5) | 5 (2.8) | 15 (14.4) | |
| 10 or more | 7 (11.9) | 2 (3.0) | 13 (19.1) | 22 (12.4) | 36 (34.6) | |
| Not given | 1 (1.7) | 0 (0.0) | 2 (2.9) | 7 (4.0) | 0 (0.0) |
Number of PCPs who have direct access to relevant imaging for lung cancer_
| Bulgaria n (%) | Croatia n (%) | Greece n (%) | Romania n (%) | Slovenia n (%) | Significance (P value) | |
|---|---|---|---|---|---|---|
| Plain X-ray | 54 (91.5) | 64 (95.5) | 66 (97.1) | 149 (84.2) | 90 (86.5) | <0.006 |
| CT and/or PET CT and/or MRI | 7 (11.9) | 16 (23.9) | 53 (77.9) | 23 (13.0) | 71 (68.3) | <0.001 |