Exploring why European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? A qualitative study

BACKGROUND: While Primary Care Physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral.

AIM: This study explores European PCPs' experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis.

DESIGN & SETTING: A multicentre European qualitative study, based on an online survey with open-ended questions asking PCPs for their narratives about cases when they had missed a diagnosis of cancer.

METHOD: Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data.

RESULTS: A total of 158 PCPs completed the questionnaire. The main themes were: where patients' descriptions did not suggest cancer; when distracting factors reduced PCPs' suspicions of cancer; when patients' hesitancy delayed the diagnosis; where system factors hampered the diagnostic process; when PCPs felt that they had made a mistake; and inadequate communication.

CONCLUSION: The study identified six overarching themes which need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The 'Swiss cheese' model of accident causation shows how the themes relate to each other.