Quality deviations in cancer diagnosis: prevalence and time to diagnosis in general practice

Jensen, Henry; Nissen, Aase; Vedsted, Peter

doi:10.3399/bjgp14x677149

Cited by 34 publications

(56 citation statements)

References 31 publications

(37 reference statements)

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“…Up to a third of all cancer patients experience at least one QD during the pre‐diagnosis (Jensen, Nissen, & Vedsted, ; Jensen, Sperling, et al, ). It has been shown that patients having experienced a QD during the primary diagnostic phase have longer diagnostic interval (Jensen, Nissen, et al, ), as the main consequence of QDs is delay (Hickner et al, ). Hence, we may suspect that part of the increased diagnostic interval (and worse experiences) seen among non‐CPP patients can be explained by a delay caused by more QDs in this group.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, we found that one-third of the differences in patient experiences between referral routes could be explained by differences in reported QDs. Up to a third of all cancer patients experience at least one QD during the pre-diagnosis (Jensen, Nissen, & Vedsted, 2014;Jensen, Sperling, et al, 2015). It has been shown that patients having experienced a QD during the primary diagnostic phase have longer diagnostic interval (Jensen, Nissen, et al, 2014), as the main consequence of QDs is delay (Hickner et al, 2008).…”

Section: Comparison With the Literaturementioning

confidence: 99%

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Cancer patients’ experiences with urgent referrals to cancer patient pathways

et al. 2018

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Objective We aimed to explore whether cancer patients urgently referred to a cancer patient pathway (CPP) (CPP referred) by a general practitioner report experiences of pre‐diagnosis cancer care differently than patients not referred to a CPP (non‐CPP referred). Methods Data were collected from cross‐sectional questionnaire surveys among cancer patients and their GPs and linked to National registries. Poisson regression was used to generate adjusted prevalence ratios (PR) to compare reported experiences. Results The study included 2,256 individuals. CPP referred patients reported more positive overall experiences of the pre‐diagnosis phase (p < 0.001). Overall, CPP referred patients were 21% more likely than non‐CPP referred patients to report a positive experience after adjustment for case‐mix, comorbidity, disposable household income and educational level (PR = 1.21 [95% CI: 1.11–1.30]). The difference decreased to 14% when adjusted for Quality Deviations (PR = 1.14 [95% CI: 1.06–1.23]) and to 11% when adjusted for diagnostic interval (PR = 1.11 [95% CI: 1.02–1.20]). Conclusion Our findings suggest that CPP referred cancer patients have better experiences of pre‐diagnosis cancer care compared to non‐CPP referred patients. A substantial part of the difference could be attributed to shorter diagnostic intervals and/or the absence of quality deviations among CPP patients, which reveals the potential for generally improving cancer patients’ experiences by seamless and optimised diagnostic pathways.

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Section: Discussionmentioning

confidence: 99%

Section: Comparison With the Literaturementioning

confidence: 99%

Cancer patients’ experiences with urgent referrals to cancer patient pathways

et al. 2018

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“…7 Delayed diagnosis may occur if the GP attributes symptoms or abnormal test results to a health problem other than cancer. 8 Some patients may then experience a prolonged and dissatisfying diagnostic pathway 9 and may express their dissatisfaction through a change of practice (COP).…”

Section: Introductionmentioning

confidence: 99%

Patients with cancer and change of general practice: a Danish population-based cohort study

et al. 2016

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“…This accords to some extent with international studies of missed opportunities in cancer diagnosis 29 30. In the UK, the updated NICE guidance explicitly recognises that patients with combinations of common symptoms may be more likely to have lung cancer than patients with any one of these symptoms alone,28 31 but patients may not volunteer all the symptoms they experience in consultations, perhaps due to real or perceived time constraints in the consultation 31.…”

Section: Discussionmentioning

confidence: 99%

Variations in GPs' decisions to investigate suspected lung cancer: a factorial experiment using multimedia vignettes

Sheringham¹,

Sequeira²,

Myles

et al. 2016

BMJ Qual Saf

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IntroductionLung cancer survival is low and comparatively poor in the UK. Patients with symptoms suggestive of lung cancer commonly consult primary care, but it is unclear how general practitioners (GPs) distinguish which patients require further investigation. This study examined how patients' clinical and sociodemographic characteristics influence GPs' decisions to initiate lung cancer investigations.MethodsA factorial experiment was conducted among a national sample of 227 English GPs using vignettes presented as simulated consultations. A multimedia-interactive website simulated key features of consultations using actors (‘patients’). GP participants made management decisions online for six ‘patients’, whose sociodemographic characteristics systematically varied across three levels of cancer risk. In low-risk vignettes, investigation (ie, chest X-ray ordered, computerised tomography scan or respiratory consultant referral) was not indicated; in medium-risk vignettes, investigation could be appropriate; in high-risk vignettes, investigation was definitely indicated. Each ‘patient’ had two lung cancer-related symptoms: one volunteered and another elicited if GPs asked. Variations in investigation likelihood were examined using multilevel logistic regression.ResultsGPs decided to investigate lung cancer in 74% (1000/1348) of vignettes. Investigation likelihood did not increase with cancer risk. Investigations were more likely when GPs requested information on symptoms that ‘patients’ had but did not volunteer (adjusted OR (AOR)=3.18; 95% CI 2.27 to 4.70). However, GPs omitted to seek this information in 42% (570/1348) of cases. GPs were less likely to investigate older than younger ‘patients’ (AOR=0.52; 95% CI 0.39 to 0.7) and black ‘patients’ than white (AOR=0.68; 95% CI 0.48 to 0.95).ConclusionsGPs were not more likely to investigate ‘patients’ with high-risk than low-risk cancer symptoms. Furthermore, they did not investigate everyone with the same symptoms equally. Insufficient data gathering could be responsible for missed opportunities in diagnosis.

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Quality deviations in cancer diagnosis: prevalence and time to diagnosis in general practice

Abstract: Background

Cited by 34 publications

References 31 publications

Cancer patients’ experiences with urgent referrals to cancer patient pathways

Cancer patients’ experiences with urgent referrals to cancer patient pathways

Patients with cancer and change of general practice: a Danish population-based cohort study

Variations in GPs' decisions to investigate suspected lung cancer: a factorial experiment using multimedia vignettes

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