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

Senada Hajdarevic; 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 Hoffman; George Kuodza; Peter Murchie; Liina Pilv; Aida Puia; Aurimas Rapalavicius; Emmanouil Smyrnakis; Birgitta Weltermann; Michael Harris

doi:10.3399/BJGPO.2023.0029

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

Department of Family Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

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 language	English
Journal	BJGP Open
DOIs	https://doi.org/10.3399/BJGPO.2023.0029
Publication status	E-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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.3399/BJGPO.2023.0029

Cite this

Hajdarevic, S., Högberg, C., Marzo-Castillejo, M., Siliņa, V., Sawicka-Powierza, J., Esteva, M., Koskela, T., Petek, D., Contreras-Martos, S., Mangione, M., Ožvačić Adžić, Z., Asenova, R., Gašparović Babić, S., Brekke, M., Buczkowski, K., Buono, N., Çifçili Saliha, S., Dinant, G-J., Doorn, B., ... Harris, M. (2023). Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? A qualitative study. BJGP Open. Advance online publication. https://doi.org/10.3399/BJGPO.2023.0029

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

abstract = "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.",

author = "Senada Hajdarevic and Cecilia H{\"o}gberg and Merc{\`e} Marzo-Castillejo and Vija Siliņa and Jolanta Sawicka-Powierza and Magadalena Esteva and Tuomas Koskela and Davorina Petek and Sara Contreras-Martos and Marcello Mangione and {O{\v z}va{\v c}i{\'c} Ad{\v z}i{\'c}}, Zlata and Radost Asenova and {Ga{\v s}parovi{\'c} Babi{\'c}}, Svjetlana and Mette Brekke and Krzysztof Buczkowski and Nicola Buono and {{\c C}if{\c c}ili Saliha}, Serap and Geert-Jan Dinant and Babette Doorn and Hoffman, {Robert D} and George Kuodza and Peter Murchie and Liina Pilv and Aida Puia and Aurimas Rapalavicius and Emmanouil Smyrnakis and Birgitta Weltermann and Michael Harris",

note = "Copyright {\textcopyright} 2023, The Authors.",

year = "2023",

month = jun,

day = "28",

doi = "10.3399/BJGPO.2023.0029",

language = "English",

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Hajdarevic, S, Högberg, C, Marzo-Castillejo, M, Siliņa, V, Sawicka-Powierza, J, Esteva, M, Koskela, T, Petek, D, Contreras-Martos, S, Mangione, M, Ožvačić Adžić, Z, Asenova, R, Gašparović Babić, S, Brekke, M, Buczkowski, K, Buono, N, Çifçili Saliha, S, Dinant, G-J, Doorn, B, Hoffman, RD, Kuodza, G, Murchie, P, Pilv, L, Puia, A, Rapalavicius, A, Smyrnakis, E, Weltermann, B & Harris, M 2023, 'Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? A qualitative study', BJGP Open. https://doi.org/10.3399/BJGPO.2023.0029

TY - JOUR

T1 - Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis?

T2 - A qualitative study

AU - Hajdarevic, Senada

AU - Högberg, Cecilia

AU - Marzo-Castillejo, Mercè

AU - Siliņa, Vija

AU - Sawicka-Powierza, Jolanta

AU - Esteva, Magadalena

AU - Koskela, Tuomas

AU - Petek, Davorina

AU - Contreras-Martos, Sara

AU - Mangione, Marcello

AU - Ožvačić Adžić, Zlata

AU - Asenova, Radost

AU - Gašparović Babić, Svjetlana

AU - Brekke, Mette

AU - Buczkowski, Krzysztof

AU - Buono, Nicola

AU - Çifçili Saliha, Serap

AU - Dinant, Geert-Jan

AU - Doorn, Babette

AU - Hoffman, Robert D

AU - Kuodza, George

AU - Murchie, Peter

AU - Pilv, Liina

AU - Puia, Aida

AU - Rapalavicius, Aurimas

AU - Smyrnakis, Emmanouil

AU - Weltermann, Birgitta

AU - Harris, Michael

PY - 2023/6/28

Y1 - 2023/6/28

N2 - 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.

AB - 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.

UR - https://www-webofscience-com.db.rsu.lv/wos/alldb/full-record/MEDLINE:37380218

U2 - 10.3399/BJGPO.2023.0029

DO - 10.3399/BJGPO.2023.0029

M3 - Article

C2 - 37380218

SN - 2398-3795

JO - BJGP Open

JF - BJGP Open

ER -