KEY TAKEAWAYS
- The study aimed to examine how COPD and symptom type influence GPs’ decision-making and lung cancer diagnosis.
- The study found only 20% of GPs considered lung cancer in persistent respiratory symptoms, regardless of COPD.
Lucy Mitchinson and the team aimed to explore how comorbid chronic obstructive pulmonary disease and symptom type affect GPs’ decisions in diagnosing lung cancer. They also investigated how these factors influence diagnostic accuracy and referral practices.
The study used a vignette survey with a 2×2 mixed factorial design to explore clinical decision-making in primary care. Conducted nationwide online, the survey involved 109 UK-based general practitioners registered on Dynata.
Participants reviewed 4 vignettes describing a 75-year-old patient with a smoking history and worsening symptoms, either general or respiratory, with or without pre-existing chronic obstructive pulmonary disease (COPD). GPs were asked to list the three most likely diagnoses and choose four management approaches from 20 pre-coded options.
The primary outcomes were the attribution of symptoms to lung cancer and the decision to refer for an urgent chest X-ray. Secondary outcomes included alternative diagnoses and management approaches. Multivariable mixed-effects logistic regression, incorporating random intercepts for individual GPs, was used for analysis.
About 422 vignettes were completed. COPD status did not predict lung cancer attribution (odds ratio [OR] = 1.1, 95% CI = 0.5-2.4, P= 0.914) or referral for an urgent chest X-ray (OR = 0.6, 95% CI = 0.3-1.2, P= 0.12). COPD status also did not predict referral when combined with symptom type (OR = 0.9, 95% CI = 0.5-1.8, P= 0.767).
The conclusion was that only 1 in 5 GPs identified lung cancer as a possible diagnosis for persistent respiratory symptoms, regardless of COPD status. Raising awareness of the connection between COPD and lung cancer may lead to more chest X-rays and referrals for diagnostic testing in symptomatic patients.
This study forms part of an NIHR Programme Grants for Applied Research (PgfAR) SPOtting Cancer among Comorbidities (SPOCC) programme: supporting clinical decision making in patients with symptoms of cancer and pre-existing conditions (NIHR201070).
Source: https://pubmed.ncbi.nlm.nih.gov/39174063/
Mitchinson L, von Wagner C, Blyth A, et al. (2024). “Clinical decision-making on lung cancer investigations in primary care: a vignette study.” BMJ Open. 2024;14(8):e082495. Published 2024 Aug 21. doi:10.1136/bmjopen-2023-082495
