Communicating cancer risk in the primary care consultation when using a cancer risk assessment tool: Qualitative study with service users and practitioners

Abstract

Background Cancer risk assessment tools are designed to help detect cancer risk in symptomatic individuals presenting to primary care. An early detection of cancer risk could mean early referral for investigations, diagnosis and treatment, helping to address late diagnosis of cancer. It is not clear how best cancer risk may be communicated to patients when using a cancer risk assessment tool to assess their risk of developing cancer. Objective We aimed to explore the perspectives of service users and primary care practitioners on communicating cancer risk information to patients, when using QCancer, a cancer risk assessment tool. Design A qualitative study involving the use of individual interviews and focus groups. Setting and participants Conducted in primary care settings in Lincolnshire with a convenience sample of 36 participants (19 service users who were members of the public) and 17 primary care practitioners (general practitioners and practice nurses). Results Participants suggested ways to improve communication of cancer risk information: personalizing risk information; involving patients in use of the tool; sharing risk information openly; and providing sufficient time when using the tool during consultations. Conclusion Communication of cancer risk information is complex and difficult. We identified strategies for improving communication with patients involving cancer risk estimations in primary care consultations.

Diagnostic uncertainty in primary care: what is known about its communication, and what are the associated ethical issues?

“…Six studies in our review provided information about why primary care physicians decide whether to communicate diagnostic uncertainty ( 2 , 16–18 , 28 , 30 ). Time constraints as a barrier to communicating information about diagnostic uncertainty were discussed ( 18 ), as was the perception that patients are intolerant of uncertainty ( 24 ), preferring ‘ black and white answers ’ ( 18 ).…”

“…In two of the studies identified, the importance of communicating about diagnostic uncertainty was discussed in the context of the principles of openness and honesty: physicians emphasized the importance of such communication in managing patient expectations ( 28 ) and building trust ( 28 , 30 ).…”

“…In two studies, participants speculated about the importance of honestly discussing uncertain diagnosis with patients in order to maintain patient–physician trust ( 28 , 30 ); neither of these studies directly measured this assertion.…”

“…The studies identified in this review provided mixed evidence on the impact of communicating diagnostic uncertainty: one study suggested a detrimental effect on patient confidence/satisfaction ( 16 ), whilst another found no impact ( 21 ). Two papers discussed the potential importance of communicating diagnostic uncertainty in maintain patient trust, but did not provide empirical evidence of this ( 28 , 30 ). The potentially harmful effects of not discussing diagnostic uncertainty were highlighted in four studies ( 26 , 28–30 ).…”

Yonder: Colonoscopy, bone health, risk communication, and task shifting

“…As these tools have not been widely adopted to date, a UK research team recently sought to explore the perspectives of patients and clinicians on their use in communicating cancer risk information. 3 Participants suggested ways to improve communication: personalising risk information; involving patients in use of the tool; sharing risk information openly; and providing sufficient time when using the tool during consultations. It is the last of these that I suspect is most critical, and frustratingly, is probably also the most challenging to ameliorate in the current healthcare climate.…”