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Cancer decision tool ‘influences GP decision on half of occasions’

An electronic cancer decision support tool influenced GPs’ decisions on whether to refer patients for suspected cancer on around half the occasions it was used, the early findings of a pilot study run by a cancer charity have revealed.

The cancer decision support tool – based on the Risk Assessment Tool (RAT) and ClinRisk cancer decision support tools – runs in the background of GP information systems and flags up when a patient is at increased risk of common cancers.

Macmillan Cancer Support, with funding from the Department of Health, has been testing use of the cancer decision support tool in over 500 practices over the past year.  

According to the Government’s third annual report on the Improving outcomes: a strategy for cancer initiative, ‘initial indications are that the cancer decision support tool influences a GP’s decision in around half of the occasions in which it is used’.

Professor Willie Hamilton, professor of primary care diagnostics at the University of Exeter, led the research to develop the RAT tool, first as a paper tool and then as an electronic system (eRATs).

Professor Hamilton told Pulse the findings were encouraging and showed the threshold for flagging risk seemed to have been set at about the right level.

He said: ‘In the eRATs, the computer automatically searched for risky symptom combinations, and then alerted the GP if the risk were above 2%. That figure – 2% - was very difficult to decide upon. We wanted to get it low enough that we would make a difference in cancer diagnostics, but not so low that the prompt went off too frequently.’

‘“Prompt fatigue” is a very real concept for GPs. To me, the figure that around half led to influencing the decision sounds perfect – a Goldilocks figure.’

‘We seem to be alerting GPs to the possibility of cancer, then they do some thinking – perhaps shared with the patient – and in some they choose to investigate. Importantly, there are some they choose not to investigate. That’s fine too.’

The Department of Health said a full evaluation of the pilot is now being done by Cancer Research UK and the DH Policy Research Unit, while Macmillan Cancer Support is working with GP IT software companies to roll out the tool more widely.

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