Clinical Decision-Making Differences Between Primary Care Physicians Using and Not Using Cancer Risk Assessment Questionnaires

Abstract

Clinical decision-making by primary care physicians is essential for early cancer detection. Structured tools for assessing cancer risk factors, including patient questionnaires, may promote systematic history taking, improve identification of warning symptoms and risk factors, and increase cancer awareness. Such tools may also support clinical reasoning and timely referral for diagnostic and screening procedures within routine primary care clinical practice settings. Purpose is to assess differences in clinical approaches and decision-making among primary care physicians depending on whether they use patient questionnaires to identify cancer risk factors. Materials and Methods. A cross-sectional analytical study involved 311 general practitioners – family physicians. Respondents were divided into two groups: physicians who did not use questionnaires to assess cancer risk factors (n=75) and physicians who used them in clinical practice (n=236). The questionnaire included sociodemographic and professional characteristics, clinical symptoms, cancer risk factors, and prescription of screening and diagnostic examinations. Statistical analysis was performed using MedCalc® Statistical Software, version 22.009. Categorical variables were compared using the χ² test or Fisher’s exact test when expected frequencies were small. Statistical significance was set at p<0.05. Results. Questionnaire use was significantly associated with physicians’ length of professional experience (p=0.007). Among physicians who used questionnaires, 42.4% had more than 20 years of professional experience compared with 21.3% among those who did not. Practice location (p=0.621) and number of patient declarations (p=0.219) were not significantly associated with questionnaire use. Physicians who used questionnaires more frequently considered gastrointestinal disturbances (67.4% vs 48.0%; p=0.004) and urinary disturbances (65.3% vs 48.0%; p=0.010) as clinically relevant. A positive family history of cancer was also more frequently taken into account by questionnaire users (90.3% vs 77.3%; p=0.006). No statistically significant differences were found for unexplained weight loss, fatigue, palpable mass, pain of unclear origin, prolonged stress, overweight, hazardous occupational conditions, low physical activity, smoking, alcohol consumption, or excessive red meat intake. Domestic or sexual violence was more frequently identified among questionnaire users, although the difference was not statistically significant (12.7% vs 5.3%; p=0.089). Questionnaire use was also associated with selected diagnostic decisions. Physicians who used questionnaires more often prescribed faecal occult blood testing (68.6% vs 54.7%; p=0.036) and tumour marker testing (26.7% vs 14.7%; p=0.042). No statistically significant differences were observed for mammography, colonoscopy, ultrasound examinations, or prostate-specific antigen testing for prostate cancer. Professional or emotional exhaustion (p=0.196), working in one versus several healthcare facilities (p=0.236), and job satisfaction (p=0.124) were not associated with questionnaire use. Overall, questionnaire use was linked to a more structured approach to cancer risk assessment, greater attention to selected clinical manifestations and family history, and certain diagnostic decisions in primary care. This may facilitate earlier identification of patients at increased cancer risk and support timely diagnostic pathways. Conclusions. The use of questionnaires for assessing cancer risk factors is associated with a more systematic approach to medical history taking, evaluation of selected clinical symptoms, identification of family cancer history, and prescription of certain diagnostic tests. Structured cancer risk assessment tools may support clinical decision-making and improve early identification of patients requiring further diagnostic evaluation.