Department for Health

The Örenäs Research Group

This University of Bath team leads the Örenäs Research Group (ÖRG), a pan-European collaborative group of primary care researchers. The ÖRG was formed in 2013 to study the factors influencing national variations in the early diagnosis of cancer in primary care. 
The ÖRG has collaborators in 34 academic and clinical centres in 25 countries: Belgium, Bulgaria, Croatia, Denmark, England, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, Latvia, Netherlands, Norway, Poland, Portugal, Romania, Scotland, Slovenia, Spain, Sweden, Switzerland and Turkey.

Why are we researching this subject?

In the UK, primary care is the main setting where cancer is diagnosed, or at least suspected. In spite of an increase in cancer diagnosis research in recent years, selection of patients for investigation continues to be complex and influenced by such issues as national policy and local availability of access to investigation by primary care doctors.
The UK’s record in cancer mortality is poor compared with most other western-European countries. It is estimated that 6-7,000 lives are lost each year in the UK from late cancer diagnosis, compared with relative survival in other Europe countries. However, there has been little research done to explain how different national systems influence a primary care doctor’s referral decisions, and how these result in such a variable survival rate.

What do we do?

The ÖRG works to provide an understanding of the interactions between health system factors and professional behaviour, so that cancer survival outcomes can be improved.


Michael Harris

o ÖRG lead and coordinator
o General Practitioner

Gordon Taylor

o Medical statistician

Sophie Harker

o MSc Health Psychology student

Recent Projects

We had funding from the European Science Foundation to run an 8-country workshop to plan our approach to this research area. 
o We used this meeting to frame our research questions, get insight into other European health-care systems, form connections and new collaborations, and formulate a research plan. The meeting took place at Örenäs in Sweden, and this gave the newly-formed collaborative group its name.
In a European symposium, we identified the system and other non-clinical factors that may influence a primary care doctor’s decision on whether to refer a patient who may have cancer. 
o Many non-clinical factors were considered to be likely to have a significant impact on referral decisions. 
o These included levels of gatekeeping responsibility, funding systems, access to special investigations, fear of litigation, and relationships with specialist colleagues.
Another pan-European study used patient vignettes (cases where the patients could have early cancer) to examine how probability of presentation to a primary care clinician correlates with national cancer survival rates. 
o The study found that the degree to which primary care doctor act as gatekeepers varies considerably from country to country. 
o There was no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.


Harris M. (2015) Örenäs national survey results. European Journal of Cancer Care 24:53

Harris M, Frey P, Esteva M, Gašparović-Babić S, Marzo-Castillejo M, Petek Ster M, Thulesius H. (2016) How health system factors influence referral decisions in patients that may have cancer: European symposium report. J Cancer Res Ther. 4(1):7-10. DOI:10.14312/2052-4994.2016-2

Harris M, Frey P, Esteva M, Gašparović-Babić S, Marzo-Castillejo M, Petek Ster M, Thulesius H. (2017) How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes. Scandinavian Journal of Primary Health Care. DOI:10.1080/02813432.2017.1288692


Current Projects

The Örenäs Research Group is just completing data collection from a pan-European survey that investigates what influences the thinking of primary care doctors when faced with patients who may have cancer, and how that compares across European countries. The research asks: In patients with symptoms that could suggest cancer:

o What health system factors affect primary care doctors’ decisions to refer patients for further investigation (specialist opinion or special investigation)? 

o How do these compare across different European countries, and how do they relate to year-1 cancer survival rates? 

The study design uses surveys that analyse primary care doctors’ decision-making and reasoning when faced with patient vignettes, as well as attitudinal statements relating to health system factors. The ÖRG is administering these surveys in 25 centres, in 20 languages, 20 of its member countries. So far, we have collected data from over 2,000 European primary care doctors, and we are making a detailed quantitative analysis. 

In this survey, there is a question asking how the doctors feel that the speed of diagnosis of cancer in primary care be improved, and 1,350 primary care doctors have written free-text responses. Our qualitative analysis will identify the key themes.

Sometimes primary care doctors delay acting on symptoms that fit into cancer referral guidelines, or ‘red flag’ symptoms that may suggest cancer. Our focus group study will explore the reasons for this.



For further information about the Örenäs Research Group, please contact Michael Harris.

Tel: +44 (0) 1761 241366 email: