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

Hajdarevic, SenadaHögberg, CeciliaMarzo-Castillejo, MercèSiliņa, VijaSawicka-Powierza, JolantaEsteva Cantó, MagdalenaKoskela, TuomasPetek, DavorinaContreras-Martos, SaraMangione, MarcelloOžvačić Adžić, ZlataAsenova, RadostGašparović Babić, SvjetlanaBrekke, MetteBuczkowski, KrzysztofBuono, NicolaÇifçili Saliha, SerapDinant, Geert-JanDoorn, BabetteHoffman, Robert DKuodza, GeorgeMurchie, PeterPilv, LiinaPuia, AidaRapalavicius, AurimasSmyrnakis, EmmanouilWeltermann, BirgittaHarris, Michael2024-10-092024-10-092023-06-28Hajdarevic, Senada; Högberg, Cecilia; Marzo-Castillejo, Mercè; Siliņa, Vija; Sawicka-Powierza, Jolanta; Esteva Cantó, Magdalena; Koskela, Tuomas; Petek, Davorina; Contreras-Martos, Sara; Mangione, Marcello; Ožvačić Adžić, Zlata; Asenova, Radost; Gašparović Babić, Svjetlana; Brekke, Mette; Buczkowski, Krzysztof; Buono, Nicola; Çifçili Saliha, Serap; Dinant, Geert-Jan; Doorn, Babette; Hoffman, Robert D; Kuodza, George; Murchie, Peter; Pilv, Liina; Puia, Aida; Rapalavicius, Aurimas; Smyrnakis, Emmanouil; Weltermann, Birgitta; Harris, Michael. Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study. BJGP Open 2023; 7 (4): BJGPO.2023.0029.https://hdl.handle.net/20.500.13003/19377https://hdl.handle.net/20.500.12105/23806Background: 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: To explore 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 as follows: patients' descriptions did not suggest cancer; distracting factors reduced PCPs' cancer suspicions; patients' hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. Conclusion: The study identified six overarching themes that 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 showed how the themes related to each other.enghttp://creativecommons.org/licenses/by/4.0/Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? A qualitative studyresearch articleAtribución 4.0 Internacional3738021810.3399/BJGPO.2023.00292398-3795BJGP openopen access