Online triage and cancer diagnostic activity in general practice: a cross-sectional study.

Abstract

Background: Patient-facing online triage tools potentially offer GPs a way to recognise cancer-related symptoms and features to facilitate appropriate suspected cancer referrals. Little is known about their impact on cancer diagnostic process and outcomes.

Aim: To describe patterns of cancer outcome and process indicators associated with the use of online triage tools in primary care.

Design and setting: This cross-sectional study examined the association between publicly reported practice-level data on 3053 English general practices. An online triage tool was used that linked to practice-level data and 31 233 594 triage forms completed using an online triage tool in 2022-2023.

Method: A cross-sectional analysis (mixed-effects regression) was conducted to evaluate the association between the annual rate of eConsult forms received (weighted to practice registrations) and various cancer diagnosis process and outcome measures.

Results: Increased use of online triage forms was associated with higher rates of urgent suspected cancer (USC) referrals and investigations; for example, there was a 7.75% difference in colonoscopy rate (95% confidence interval [CI] = 3.83% to 8.98%) across the 90% mid-range of practices. Despite this, there was no evidence of an association with USC referrals resulting in diagnosis or emergency presentations.

Conclusion: Greater use of online triage forms is associated with more investigations and referrals for suspected cancer, but not associated with better diagnostic outcomes. This may indicate that any additional referrals are of lower quality and overall there is an increase in inappropriate use of USC referrals. Research is needed to understand how this impacts investigations and referrals for individual patients.