Facilitating early diagnosis of lung cancer amongst primary care patients: The views of GPs

Abstract

Early diagnosis of lung cancer (LC) is a policy priority. However, symptoms are vague, associated with other morbidities, and frequently unrecognised by both patients and general practitioners (GPs). This qualitative study, part of a larger mixed methods study, explored GP views regarding the potential for early diagnosis of LC within primary care. Five focus group discussions (FGDs) were conducted with GPs (n = 16) at primary care practices (n = 5) across four counties in south England. FGDs were audio‐recorded, transcribed verbatim and analysed using a framework approach. Four broad themes emerged: patients’ reporting of symptoms; GP response to symptoms; investigating LC, and; potential initiatives for early diagnosis. GPs reported they often required high levels of suspicion to refer patients on to specialist respiratory consultations, and concerns of ‘system overload’ were prevalent. Greater access to more sensitive diagnostic investigations such as computed tomography, was argued for by some, particularly for symptomatic patients with negative chest X‐rays. GPs challenged current approaches to promoting earlier diagnosis through national symptom awareness campaigns, arguing instead that interventions targeted at high‐risk individuals might be more effective without burdening services already under pressure. Further work is needed to identify primary care patients who might most benefit from such targeted interventions.

Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms

“…Some studies 47,78,[80][81][82] only examined the overall effect of any disease (rather than specific diseases) on the diagnostic process ( Figure 1).…”

“…On the other hand evidence on the effects of specific chronic diseases is provided by several studies 2,46,66,69,70,72,73,79,[82][83][84][85] . In particular, congestive heart failure or coronary artery disease can lead to missed opportunities to refer patients promptly for endoscopic examination 84 , despite symptoms of colorectal cancer.…”

Lung cancer

“…Factors associated with later presentation include limited awareness of cancer symptoms and fear of cancer,6 concerns about wasting their own and general practitioners’ time,7 and stoicism and stigma around smoking 8…”

GPs’ perspectives of the patient encounter – in the context of standardized cancer patient pathways

“…Furthermore, one study has found that GPs readiness to act on symptoms is associated with improved cancer survival, and that Swedish GPs are more prone to act on symptoms than for example GPs in UK [37]. Nevertheless, GPs sometimes fail to recognize specific alarm symptoms [38], indicating that GPs do not respond directly to symptoms as objective things and that GPs assign meanings to symptoms by interacting with patients. Besides, since the introduction of CPPs the playing field has changed, meaning that GPs now have to match their knowledge through interacting with CPPs', not only with patients.…”