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

Background: England is short of GPs, and GP consultation rates, consultation duration, and workload are increasing. Electronic clinical decision support tools assist decision making for screening, diagnosis, and risk management. Cancer detection is one area in which tools are designed to support GPs, with some electronic risk assessment tools (eRATs) estimating the risk of current cancer based on symptoms.

Aim: To explore any association between the impact of eRATs and GP workload and workflow during consultations.

Design and setting: Observational sub-study.

Method: Thirteen practices in England participating in a cluster randomised controlled trial of eRATs were recruited to the study. Using mixed-effects regression models, the average duration of consulting sessions and individual consultations in which eRATs were, or were not, activated were compared.

Results: There was no evidence that consulting sessions in which an eRAT was activated were, on average, longer than sessions in which an eRAT had not been activated. However, after adjusting for a range of session and consultation characteristics, individual consultations involving an eRAT were longer, on average, by 3.96 minutes (95% confidence interval = 3.45 to 4.47; P<0.001) when compared with consultations with no eRAT.

Conclusion: There was no evidence to suggest that eRATs should not be used to support GPs in early cancer diagnosis from a workload perspective. Activation of eRATs was not associated with increased workload across a consulting session, despite a small increase in time observed in individual consultations involving eRATs. Ultimately, therefore, it should be definitive findings regarding the clinical effectiveness of eRATs, not the related workload/workflow implications, that determine whether the use of eRATs should be rolled out more widely.