Strengths and limitations of this study
A novel, large and logistically complicated study using a validated survey.
Data were analysed from 2795 primary care physicians (PCPs) across 11 jurisdictions.
Response rates were suboptimal (ranging from 5.5% in England and British Columbia to 45.6% in Manitoba) and respondents were not totally representative of the PCPs in all jurisdictions.
It is difficult to assess the effect of these weaknesses on the interpretation of results but sensitivity analyses and the literature suggest it would not be large.
Principal findingsUsing an online survey in 11 jurisdictions, we have demonstrated a correlation that suggests a relationship between the readiness of PCPs to investigate or refer for suspected cancer and cancer survival in each jurisdiction. This is the first time that readiness to investigate cancer—either directly or by referral to secondary care—has been shown to correlate with cancer survival. Evidence suggests that variations between healthcare systems have an impact on health outcomes.24 There is significant variation between jurisdictions in PCP's access to diagnostic tests. Whether greater access to tests improves outcomes depends on the sensitivity of the test and how the waiting time for test results compares with the waiting time if a referral is made. PCPs may not be aware of the fastest way to diagnose cancer: referral or primary care investigation. Our data indicate significantly long waits in some jurisdictions for the results of tests undertaken in primary care. However, access to tests was not associated with readiness to investigate or refer. Further research is required in this complex area.