Exploring GPs’ experiences of using diagnostic tools for cancer: a qualitative study in primary care

Green, Trish; Martins, Tanimola; Hamilton, William; Rubin, Greg; Elliott, Kathy; Macleod, Una

doi:10.1093/fampra/cmu081

Cited by 29 publications

(44 citation statements)

References 15 publications

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“…The reason for this could be that the GPs’ awareness of potential cancer symptoms and attitude towards urgent cancer referral changed through the CME-M. Similar results have also been found in qualitative studies about the use of RATs [44, 45] and in our previous analysis of the impact of the CME-M on GP knowledge, attitude and intentions [18]. …”

Section: Discussionsupporting

confidence: 79%

“…Our intervention was developed on the basis of theoretical frameworks and reviews of empirical results to ensure optimal likelihood of positive effect [44–47]. The CME-M consisted of a variety of elements [18], and we could not validly identify the most effective parts of the CME-M; this calls for further research in changing the GPs’ behaviour [46].…”

Section: Discussionmentioning

confidence: 99%

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Impact of a continuing medical education meeting on the use and timing of urgent cancer referrals among general practitioners - a before-after study

et al. 2017

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BackgroundDetection of cancer in general practice is challenging because symptoms are diverse. Even so-called alarm symptoms have low positive predictive values of cancer. Nevertheless, appropriate referral is crucial. As 85% of cancer patients initiate their cancer diagnostic pathway in general practice, a Continuing Medical Education meeting (CME-M) in early cancer diagnosis was launched in Denmark in 2012. We aimed to investigate the effect of the CME-M on the primary care interval, patient contacts with general practice and use of urgent cancer referrals.MethodsA before-after study was conducted in the Central Denmark Region included 396 general practices, which were assigned to one of eight geographical clusters. Practices were invited to participate in the CME-M with three-week intervals between clusters. Based on register data, we calculated urgent referral rates and patient contacts with general practice before referral. Information about primary care intervals was collected by requesting general practitioners to complete a one-page form for each urgent referral during an 8-month period around the time of the CME-Ms. CME-M practices were compared with non-participating reference practices by analysing before-after differences.ResultsForty percent of all practices participated in the CME-M. There was a statistically significant reduction in the number of total contacts with general practice from urgently referred patients in the month preceding the referral and an increase in the proportion of patients who waited 14 days or more in general practice from the reported date of symptom presentation to the referral date from before to after the CME-M in the CME-M group compared to the reference group.ConclusionsWe found a reduced number of total patient contacts with general practice within the month preceding an urgent referral and an increase in the reported primary care intervals of urgently referred patients in the CME-M group. The trend towards higher urgent referral rates and longer primary care intervals may suggest raised awareness of unspecific cancer symptoms, which could cause the GP to register an earlier date of first symptom presentation. The standardised CME-M may contribute to optimising the timing and the use of urgent cancer referral.Trial registration NCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0607-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Impact of a continuing medical education meeting on the use and timing of urgent cancer referrals among general practitioners - a before-after study

et al. 2017

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“…Green et al reported further qualitative results from a subgroup of the Hamilton study, 21 showing that the majority of GPs reported finding the tool useful in consultations, heightening their awareness of potential cancer symptoms, reminding them of potential cancer risks, and affecting their referral thresholds, although not all of the participating GPs found the tool a valuable addition to their practice. 22 Similar results were reported by Dikomitis et al; a qualitative study that examined 23 GPs' experiences of using an electronic version of the tool (one for smokers and one for non-smokers) in addition to their practices' clinical software package. 23 The GPs in the study by Dikomitis et al reported that the tool raised their awareness of the potential for cancer as the cause of the symptoms, and that their referral rates were affected to varying degrees, but the authors of the study undertook no quantitative measurements of actual impact; for example, referral rates, new cancers diagnosed, or stage of new cancers diagnosed.…”

Section: Data Collection and Analysissupporting

confidence: 76%

Lung cancer in symptomatic patients presenting in primary care: a systematic review of risk prediction tools

et al. 2017

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“…However, our study has also shown that only people presenting with shorter histories of rectal bleeding are investigated promptly, and that healthcare professionals should remain alert to symptoms of possible CRC in people with a history of gastro-intestinal or mental health conditions. The increasingly widespread use of clinical decision support in primary care can also be informed by our findings (Dikomitis et al , 2015; Green et al , 2015), but further research is needed, alongside GPs and specialists, to identify mechanisms by which patients can be identified, referred and diagnosed in the most timely and appropriate way.…”

Section: Discussionmentioning

confidence: 78%

Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study

et al. 2016

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Background:The objective of this study is to investigate symptoms, clinical factors and socio-demographic factors associated with colorectal cancer (CRC) diagnosis and time to diagnosis.Methods:Prospective cohort study of participants referred for suspicion of CRC in two English regions. Data were collected using a patient questionnaire, primary care and hospital records. Descriptive and regression analyses examined associations between symptoms and patient factors with total diagnostic interval (TDI), patient interval (PI), health system interval (HSI) and stage.Results:A total of 2677 (22%) participants responded; after exclusions, 2507 remained. Participants were diagnosed with CRC (6.1%, 56% late stage), other cancers (2.0%) or no cancer (91.9%). Half the cohort had a solitary first symptom (1332, 53.1%); multiple first symptoms were common. In this referred population, rectal bleeding was the only initial symptom more frequent among cancer than non-cancer cases (34.2% vs 23.9%, P=0.004). There was no evidence of differences in TDI, PI or HSI for those with cancer vs non-cancer diagnoses (median TDI CRC 124 vs non-cancer 138 days, P=0.142). First symptoms associated with shorter TDIs were rectal bleeding, change in bowel habit, ‘feeling different' and fatigue/tiredness. Anxiety, depression and gastro-intestinal co-morbidities were associated with longer HSIs and TDIs. Symptom duration-dependent effects were found for rectal bleeding and change in bowel habit.Conclusions:Doctors and patients respond less promptly to some symptoms of CRC than others. Healthcare professionals should be vigilant to the possibility of CRC in patients with relevant symptoms and mental health or gastro-intestinal comorbidities.

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Exploring GPs’ experiences of using diagnostic tools for cancer: a qualitative study in primary care

Abstract: Findings suggest that the embedding of clinical decision support tools into clinical practice is more likely to be achieved when they are perceived to support but not supersede the clinical judgement of their users. This element of our findings is a focal point of this article.

Cited by 29 publications

References 15 publications

Impact of a continuing medical education meeting on the use and timing of urgent cancer referrals among general practitioners - a before-after study

Impact of a continuing medical education meeting on the use and timing of urgent cancer referrals among general practitioners - a before-after study

Lung cancer in symptomatic patients presenting in primary care: a systematic review of risk prediction tools

Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study

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