How does the thought of cancer arise in a general practice consultation? Interviews with GPs

Abstract

Background. Only a few patients on a GP's list develop cancer each year. To find these cases in the jumble of presented problems is a challenge. Objective. To explore how general practitioners (GPs) come to think of cancer in a clinical encounter. Design. Qualitative interviews with Norwegian GPs, who were invited to think back on consultations during which the thought of cancer arose. The 11 GPs recounted and reflected on 70 such stories from their practices. A phenomenographic approach enabled the study of variation in GPs’ ways of experiencing. Results. Awareness of cancer could arise in several contexts of attention: (1) Practising basic knowledge: explicit rules and skills, such as alarm symptoms, epidemiology and clinical know-how; (2) Interpersonal awareness: being alert to changes in patients’ appearance or behaviour and to cues in their choice of words, on a background of basic knowledge and experience; (3) Intuitive knowing: a tacit feeling of alarm which could be difficult to verbalize, but nevertheless was helpful. Intuition built on the earlier mentioned contexts: basic knowledge, experience, and interpersonal awareness; (4) Fear of cancer: the existential context of awareness could affect the thoughts of both doctor and patient. The challenge could be how not to think about cancer all the time and to find ways to live with insecurity without becoming over-precautious. Conclusion: The thought of cancer arose in the relationship between doctor and patient. The quality of their interaction and the doctor's accuracy in perceiving and interpreting cues were decisive.

Key Words::

• Cancer
• diagnosis
• doctor–patient relations
• general practice
• Norway
• phenomenography
• qualitative research

Acknowledgements

Profound gratitude is extended to participating GPs and to all colleagues who have read, discussed, and commented during the research and writing process.

Funding body

The Research Foundation for General Practice and the National Centre for Rural Medicine, Norway.

Ethical approval

The study has been approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (Ref 200503439-10/IAY/400) and by the Data Inspectorate of Norway (Ref 05/ 01607-9/CGN).

Author’s note

The original idea of the study came from KAH. All authors discussed the study design and developed the protocols. MLJ and CER performed the analysis. The article manuscript was written by MLJ, supervised by CER, and critically revised by KAH.

Declaration of interest The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.