Psychiatric disorders and the cancer diagnostic process in general practice: a combined questionnaire and register study exploring the patients’ experiences in Denmark

Abstract

Objective

Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice.

Design

Cross-sectional study using questionnaire and register data.

Setting

General practice in Denmark.

Subjects

Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients’ experiences.

Main outcome measures

Patients’ experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation.

Box 1. Included survey items on the patients’ experiences

Table

Results

A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP’s abilities, and the patients’ knowledge of the process following the GP referral.

Conclusion

The patients’ experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders.

KEY POINTS

• It is unknown how patients with psychiatric disorders perceive the cancer diagnostic process in general practice.

• This study found an association between having a psychiatric disorder and more often perceiving the time interval as too short between the first booking of a consultation and the first GP consultation.

• An association was found between having a primary care treated psychiatric disorder and being worried about cancer and more often sharing these concerns with the GP.

• Experiences with the cancer diagnostic process in general practice did not differ between patients with a hospital treated psychiatric disorder and patients with no indication of psychiatric disorders.

Keywords:

• (MeSH): Denmark
• neoplasms
• early detection of cancer
• mental disorders
• general practice

Acknowledgements

We wish to thank the Danish Cancer Society and the Danish General Practice Fund for funding this project. The funders were not involved in conducting the study and interpreting the results. We also wish to thank Kaare Rud Flarup for assistance on data management and Lone Niedziella for linguistic revision. Most importantly, we wish to thank the Danish Cancer Society for collecting the data and the patients who participated in the survey, which made this research project possible.

Ethics statement

The project is registered in the Record of Processing Activities at the Research Unit for General Practice, Aarhus (ID 951) in accordance with the Danish Data Protection Act (Act No. 502 of 23 May 2018) and the General Data Protection Regulation (GDPR) by the EU. As the data are based solely on registry and questionnaire data, approval by the Committee on Health Research Ethics in the Central Denmark Region was not required.

Authors contributions

LFV and PV conceived the concept of the study. All authors contributed with input and critical revision of the methods, analyses and the contents of the paper. AZF contributed with statistical guidance and critical revision of the paper. LFV was primarily responsible for drafting the manuscript and the statistical analyses. All authors read and approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data used in this study are stored at Statistics Denmark and can only be accessed by a remote access (VPN) server, which is in line with the Danish regulations of research. Therefore, the data used in this study are not openly available.

Additional information

Funding

This work was supported by the Danish Cancer Society (Kræftens Bekæmpelse) and The Danish General Practice Fund (Fonden for Almen Praksis).