How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis

Michael Harris (Corresponding Author), Hans Thulesius, Ana Luísa Neves, Sophie Harker, Tuomas Koskela, Davorina Petek, Robert Hoffman, Mette Brekke, Krzysztof Buczkowski, Nicola Buono, Emiliana Costiug, Geert-Jan Dinant, Gergana Foreva, Eva Jakob, Mercè Marzo, Peter Murchie, Jolanta Sawicka-Powierza, Antonius Schneider, Emmanouil Smyrnakis, Sven StreitGordon Taylor, Peter Vedsted, Birgitta Weltermann, Magdalena Esteva

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Background National European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis. Objectives This study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagnosis could be improved. Design In an online survey, a final open-ended question asked PCPs how they thought the speed of diagnosis of cancer in primary care could be improved. Thematic analysis was used to analyse the data. Setting A primary care study, with participating centres in 20 European countries. Participants A total of 1352 PCPs answered the final survey question, with a median of 48 per country. Results The main themes identified were: patient-related factors, including health education; care provider-related factors, including continuing medical education; improving communication and interprofessional partnership, particularly between primary and secondary care; factors relating to health system organisation and policies, including improving access to healthcare; easier primary care access to diagnostic tests; and use of information technology. Re-allocation of funding to support timely diagnosis was seen as an issue affecting all of these. Conclusions To achieve more timely cancer diagnosis, health systems need to facilitate earlier patient presentation through education and better access to care, have well-educated clinicians with good access to investigations and better information technology, and adequate primary care cancer diagnostic pathway funding.
Original languageEnglish
Article numbere030169
Number of pages9
JournalBMJ Open
Issue number9
Early online date24 Sept 2019
Publication statusPublished - 2019

Bibliographical note

The authors would like to thank all the PCPs who piloted the questionnaire and those who completed the survey. The authors would also like to thank the following non-author contributors: Isabelle Aubin-Auger (Université Paris Diderot, Paris, France), Joseph Azuri (Tel Aviv University, Tel Aviv, Israel), Svjetlana Gašparović Babić (The Teaching Institute of Public Health of Primorsko-goranska County, Rijeka, Croatia) and Marija Petek Šter (University of Ljubljana, Ljubljana, Slovenia).

Funding: This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. ALN is supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre, with infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC).


  • Cancer
  • Consultation and Referral
  • Delivery of Health Care
  • Diagnosis
  • General Practitioners
  • Primary Health Care


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