Impact of targeted wording on response rates to a survey of general practitioners on referral processes for suspected head and neck cancer: an embedded randomised controlled trial
Rebecca L. Venchiarutti
1 2 * , Marguerite Tracy 1 , Jonathan R. Clark 2 3 4 , Carsten E. Palme 2 3 4 , Jane M. Young 1 5
1 Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia.
2 Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Camperdown, 119-143 Missenden Road, NSW 2050, Australia.
3 Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia.
4 Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia.
5 The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Camperdown, NSW 2006, Australia.
Journal of Primary Health Care 14(3) 200-206 https://doi.org/10.1071/HC21095
Published: 10 June 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: Low response rates to surveys can lead to non-response bias, limiting generalisability of findings. When survey topics pertain to uncommon conditions, the decision of general practitioners (GPs) to complete a questionnaire may be swayed by the perceived relevance of the questionnaire content to their practice.
Aim: To explore whether targeted wording of a questionnaire for GPs about head and neck cancer referral patterns affects response rates.
Methods: A randomised controlled trial was embedded into a larger survey on referral practices for head and neck cancer among GPs in New South Wales, Australia. GPs were randomly allocated to receive versions of the study material with explanatory text written using either a ‘symptom-frame’ or a ‘cancer-frame’; however, the questions and responses were the same in both groups.
Results: The overall response rate was 10.9% (196/1803). The response rate to the ‘cancer-frame’ version was 10.6% and 11.1% for the ‘symptom-frame’ version. After adjusting for practice location and GP gender, the difference in response rate based on wording was not significant (difference 0.5% [95%CI: −2.4, 3.4%]). A sub-analysis showed that GPs practicing in regional New South Wales were more likely to respond to the survey compared to those practicing in metropolitan New South Wales, independent of the intervention group or participant sex (AOR 1.61 [95%CI: 1.12, 2.31]; P = 0.01).
Discussion: The wording ‘frame’ of the survey did not appear to impact response rates in a survey of referral practices for suspected head and neck cancer; however, the significantly higher response rate from regional GPs warrants further investigation as to whether the content was considered more salient to their practice.
Keywords: diagnosis delay, general practice, geography, head and neck cancer, health-care access, primary care, randomised controlled trial, variation.
References
[1] Bonevski B, Magin P, Horton G, et al. Response rates in GP surveys - trialling two recruitment strategies. Aust Fam Physician 2011; 40 427–30.| Response rates in GP surveys - trialling two recruitment strategies.Crossref | GoogleScholarGoogle Scholar | 21655493PubMed |
[2] Freed GL, Turbitt E, Kunin M, et al. General practitioner perspectives on referrals to paediatric public specialty clinics. Aust Fam Physician 2016; 45 747–53.
| General practitioner perspectives on referrals to paediatric public specialty clinics.Crossref | GoogleScholarGoogle Scholar | 27695726PubMed |
[3] Pirotta M, Kotsirilos V, Brown J, et al. Complementary medicine in general practice - a national survey of GP attitudes and knowledge. Aust Fam Physician 2010; 39 946–50.
| Complementary medicine in general practice - a national survey of GP attitudes and knowledge.Crossref | GoogleScholarGoogle Scholar | 21301677PubMed |
[4] Young JM, O’Halloran A, McAulay C, et al. Unconditional and conditional incentives differentially improved general practitioners’ participation in an online survey: randomized controlled trial. J Clin Epidemiol 2015; 68 693–97.
| Unconditional and conditional incentives differentially improved general practitioners’ participation in an online survey: randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 25450450PubMed |
[5] Edwards PJ, Roberts I, Clarke MJ, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2009; 2009 MR000008
| Methods to increase response to postal and electronic questionnaires.Crossref | GoogleScholarGoogle Scholar |
[6] Pit SW, Vo T, Pyakurel S. The effectiveness of recruitment strategies on general practitioner’s survey response rates – a systematic review. BMC Med Res Methodol 2014; 14 76
| The effectiveness of recruitment strategies on general practitioner’s survey response rates – a systematic review.Crossref | GoogleScholarGoogle Scholar | 24906492PubMed |
[7] National Cancer Control Initiative. The Primary Care Perspective on Cancer - An Introductory Discussion. 2003. Available at https://www.canceraustralia.gov.au/sites/default/files/publications/primarycaresummary1_504af01edc922.pdf [Accessed 12 October 2020]
[8] Alho O-P, Teppo H, Mäntyselkä P, et al. Head and neck cancer in primary care: presenting symptoms and the effect of delayed diagnosis of cancer cases. CMAJ 2006; 174 779–84.
| Head and neck cancer in primary care: presenting symptoms and the effect of delayed diagnosis of cancer cases.Crossref | GoogleScholarGoogle Scholar | 16534084PubMed |
[9] PHN Central and Eastern Sydney. About Central and Eastern Sydney PHN. 2021. Available at https://www.cesphn.org.au/who-we-are/about-cesphn [Accessed 19 May 2021].
[10] PHN North Coast. About NCPHN. 2021. Available at https://ncphn.org.au/about [Accessed 19 May 2021].
[11] Rashidian A, van der Meulen J, Russell I. Differences in the contents of two randomized surveys of GPs’ prescribing intentions affected response rates. J Clin Epidemiol 2008; 61 718–21.
| Differences in the contents of two randomized surveys of GPs’ prescribing intentions affected response rates.Crossref | GoogleScholarGoogle Scholar | 18359606PubMed |
[12] Groves RM, Singer E, Corning A. Leverage-saliency theory of survey participation: description and an illustration. Public Opin Q 2000; 64 299–308.
| Leverage-saliency theory of survey participation: description and an illustration.Crossref | GoogleScholarGoogle Scholar | 11114270PubMed |
[13] Groves RM, Presser S, Dipko S. The role of topic interest in survey participation decisions. Public Opin Q 2004; 68 2–31.
| The role of topic interest in survey participation decisions.Crossref | GoogleScholarGoogle Scholar |
[14] Rose PW, Rubin G, Perera-Salazar R, et al. Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey. BMJ Open 2015; 5 e007212
| Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey.Crossref | GoogleScholarGoogle Scholar | 26017370PubMed |
[15] Brtnikova M, Crane LA, Allison MA, et al. A method for achieving high response rates in national surveys of U.S. primary care physicians. PLoS One 2018; 13 e0202755
| A method for achieving high response rates in national surveys of U.S. primary care physicians.Crossref | GoogleScholarGoogle Scholar | 30138406PubMed |
