The association between cancer risk assessment tool use and GP consultation duration: an observational study.

Background: England is short of General Practitioners (GPs). GP consultation rates, consultation duration, and workload are increasing. Electronic clinical decision support (eCDS) tools assist decision-making for screening, diagnosis, and risk-management. Cancer detection is one area where tools are designed to support GPs. Electronic risk assessment tools (eRATs) estimate risk of current cancer based on symptoms. We aimed to explore any association between eRATs impact and GP workload and workflow during consultations.

Methods: Thirteen practices participating in a cluster randomised controlled trial of eRATs (ERICA) were recruited to an observational sub-study. We compared the average duration of consulting sessions and consultations where eRATs were or were not activated, using mixed effects regression models.

Results: there was no evidence that sessions where an eRAT was activated were, on average, longer than sessions where no eRATs had been activated. However, individual consultations involving an eRAT were longer on average by 3.96 minutes (95% CI: 3.45 to 4.47; p<0.001), when compared with consultations with no eRATs , after adjusting for a range of session and consultation characteristics.

Conclusions: There was no evidence to suggest that eRATs should not be used to support GPs in early cancer diagnosis from a workload perspective. eRATs were not associated with increased workload across a session. Definitive findings regarding the clinical effectiveness of eRATs, not the related workload/workflow implications, will ultimately determine whether the use of eRATs should be rolled out more widely.