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

Senada Hajdarevic (Coresponding Author), Cecilia Högberg, Mercè Marzo-Castillejo, Vija Siliņa, Jolanta Sawicka-Powierza, Magadalena Esteva, Tuomas Koskela, Davorina Petek, Sara Contreras-Martos, Marcello Mangione, Zlata Ožvačić Adžić, Radost Asenova, Svjetlana Gašparović Babić, Mette Brekke, Krzysztof Buczkowski, Nicola Buono, Serap Çifçili Saliha, Geert-Jan Dinant, Babette Doorn, Robert D HoffmanGeorge Kuodza, Peter Murchie, Liina Pilv, Aida Puia, Aurimas Rapalavicius, Emmanouil Smyrnakis, Birgitta Weltermann, Michael Harris

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
JournalBJGP Open
Publication statusE-pub ahead of print - 28 Jun 2023

Field of Science*

  • 3.3 Health sciences

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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