What would primary care practitioners do differently after a delayed cancer diagnosis? Learning lessons from their experiences

Abstract

Objective

Diagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians’ (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis.

Design

A qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data.

Setting and subjects

A primary care study, with narratives from 159 PCPs in 23 European countries.

Main outcome measures

PCPs’ narratives on the question ‘If you saw this patient with cancer presenting in the same way today, what would you do differently?

Results

The main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and ‘I wouldn’t do anything differently’.

Conclusion (Implications)

To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients’ clinical conditions.

KEY POINTS

• Diagnosing cancer in primary care is challenging due to the low incidence of cancer in practice and the multiple confounding factors that are involved in the diagnostic process.

• The need to think broadly, make improvements in communication and clinical management, and use other available resources were the main themes from Primary Care Physicians’ (PCPs’) narratives about their learning experiences from missed or late cancer diagnoses.

• A long-term, holistic and active approach with effective communication, follow-up and continuing re-assessment of the patients’ clinical conditions was another theme for making improvements.

• Some PCPs, on reflection, would not have done anything differently.

Keywords:

• Cancer
• diagnostic errors
• Europe
• primary care physicians
• primary health care
• qualitative research

Acknowledgements

We would like to thank all the PCPs who piloted the questionnaire and those who completed the survey. We would also like to thank the European GP Research Network for its support. The authors would also like to thank the following non-author contributors: Juliette Klein Hesselink, Maastricht University, Netherlands; Mateja Kokalj Kokot, University of Ljubljana, Slovenia; Iryna Mykyta Uzhhorod, National University, Ukraine; Bernardino Oliva-Fano, Calvia Heath Centre, Mallorca, Spain; Milou Rademaeker, Maastricht University, Netherlands; Marija Petek Šter, University of Ljubljana, Slovenia; Hans Thulesius, Lund University, Sweden; Wojciech Wawrzynek, Roscommon Medical Centre, Ireland; Galia Zacay, Tel; Aviv University, Israel.

Authors’ contributions

All authors participated in the study, were involved in the data collection and analysis, contributed to the manuscript, and approved the final version. TK, DP, ME and MM organized the first versions of the themes and the sub-themes, which were later approved by the rest of the group. The first version of the manuscript was written by TK, DP, ME and MM.

Data sharing

To avoid the risk of identification of individual participants or patients, the datasets generated and analysed during the current study are not publicly available. However, they are available (with any identifying information redacted) from the corresponding author on reasonable request.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical considerations

See supplementary file. The University of Bern, Switzerland, recruited participants from five of the countries in the study. In the other countries, invitations were sent by local study leads, and these leads either achieved local ethical approval or gave statements that formal ethical approval was not needed in their jurisdictions.