{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T14:54:47Z","timestamp":1791644087348,"version":"4.3.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T00:00:00Z","timestamp":1593561600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C33754\/A17871"],"award-info":[{"award-number":["C33754\/A17871"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Decis Making"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:p>Background. In previous research, we employed a signal detection approach to measure the performance of general practitioners (GPs) when deciding about urgent referral for suspected lung cancer. We also explored associations between provider and organizational performance. We found that GPs from practices with higher referral positive predictive value (PPV; chance of referrals identifying cancer) were more reluctant to refer than those from practices with lower PPV. Here, we test the generalizability of our findings to a different cancer. Methods. A total of 252 GPs responded to 48 vignettes describing patients with possible colorectal cancer. For each vignette, respondents decided whether urgent referral to a specialist was needed. They then completed the 8-item Stress from Uncertainty scale. We measured GPs\u2019 discrimination ( d\u2032) and response bias (criterion; c) and their associations with organizational performance and GP demographics. We also measured correlations of d\u2032 and c between the 2 studies for the 165 GPs who participated in both. Results. As in the lung study, organizational PPV was associated with response bias: in practices with higher PPV, GPs had higher criterion (b = 0.05 [0.03 to 0.07]; P &lt; 0.001), that is, they were less inclined to refer. As in the lung study, female GPs were more inclined to refer than males (b = \u22120.17 [\u22120.30 to \u22120.105]; P = 0.005). In a mediation model, stress from uncertainty did not explain the gender difference. Only response bias correlated between the 2 studies ( r = 0.39, P &lt; 0.001). Conclusions. This study confirms our previous findings regarding the relationship between provider and organizational performance and strengthens the finding of gender differences in referral decision making. It also provides evidence that response bias is a relatively stable feature of GP referral decision making.<\/jats:p>","DOI":"10.1177\/0272989x20936212","type":"journal-article","created":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T06:04:13Z","timestamp":1593583453000},"page":"746-755","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Disentangling the Relationship between Physician and Organizational Performance: A Signal Detection Approach"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9643-0838","authenticated-orcid":false,"given":"Olga","family":"Kostopoulou","sequence":"first","affiliation":[{"name":"Imperial College London, Department of Surgery and Cancer, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4252-4692","authenticated-orcid":false,"given":"Martine","family":"Nurek","sequence":"additional","affiliation":[{"name":"Imperial College London, Department of Surgery and Cancer, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan C.","family":"Delaney","sequence":"additional","affiliation":[{"name":"Imperial College London, Department of Surgery and Cancer, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,7,1]]},"reference":[{"key":"bibr1-0272989X20936212","unstructured":"ecancer News. World Cancer Day 2019: global cancer experts call for urgent action to improve early cancer detection. Available from: https:\/\/ecancer.org\/news\/15350-world-cancer-day-2019\u2014global-cancer-experts-call-for-urgent-action-to-improve-early-cancer-detection.php. Published 2019. 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