Lung cancer vignettes: guideline adherence and definitive action
| UK | Europe | Canada | Australia | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Wales | Northern Ireland | England | Denmark | Norway | Sweden | Manitoba | Ontario | New South Wales | Victoria | |
| 1-year lung cancer survival, % | 28.5 | 30.6 | 29.7 | 34.9 | 39.5 | 43.6 | 42.7 | 43.4 | 42.9 | 42.7 |
| Vignette one summary: 68-year-old female ex-smoker, persistent cough for 3 weeks following URTI with some sputum, examination unremarkable (PPV 0.9%) | ||||||||||
| Definitive action taken by clinician, % | 42 | 50 | 51 | 81 | 82 | 83 | 69 | 51 | 52 | 48 |
| % (95% CI) | 47 (42 to 53) | 67 (64 to 70)a | ||||||||
| Action recommended by guideline | CXR | CXR | CXR | NDG | No guideline | CXR | No guideline | CXR | CXR | CXR |
| Adherence to guideline, % | 42 | 50 | 51 | – | – | 82 | – | 50 | 51 | 46 |
| % (95% CI) | 47 (42 to 53) | 58 (54 to 61)a | ||||||||
| Vignette two summary: 62-year-old male smoker with COPD presents with 1-week history of URTI with increased sputum production, crepitation’s left base (PPV 3.6%) | ||||||||||
| Definitive action taken by clinician, % | 4 | 0 | 8 | 23 | 17 | 24 | 53 | 40 | 30 | 31 |
| % (95% CI) | 5 (1 to 9) | 31 (27 to 34)a | ||||||||
| Action recommended by guideline | NDG | NDG | NDG | NDG | No guideline | CXR | No guideline | NDG | NDG | NDG |
| Adherence to guideline, % | – | – | – | – | – | 24 | – | – | – | – |
↵a P<0.01 for difference between UK and non-UK jurisdictions.
COPD = chronic obstructive pulmonary disease. CXR = chest X-ray. NDG = not defined in guideline. PPV = positive predictive value. URTI = upper respiratory tract infection.