Cancer risk assessment tools and GP consultation workload: an observational study

Problem

England has a shortage of General Practitioners (GPs). Consultation rates, consultation duration, and GP 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 assess eRATs’ impact on GP workload and workflow during consultations.

Approach

Thirteen practices participating in the intervention arm of a pragmatic cluster randomised controlled trial of eRATs (ERICA) were recruited to an observational study. We measured the average duration of consulting sessions and consultations where eRATs were activated.

Findings

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 . Consultations occurring immediately after one where an eRAT was activated were similar duration to consultations occurring in sessions where no eRATs were activated.

Consequences

There was no evidence to suggest that eRATs should not be used to support GPs in early cancer diagnosis from a workload perspective. eRATs did not increase 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.