Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

Stephanie Archer; Natalia Calanzani; Stephanie Honey; Margaret Johnson; Richard Neal; Suzanne E Scott; Fiona M Walter

doi:10.3399/BJGPO.2021.0056

Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

Stephanie Archer, Natalia Calanzani, Stephanie Honey, Margaret Johnson, Richard Neal, Suzanne E Scott, Fiona M Walter

Applied Health Sciences

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Abstract

Background Early diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic.Aim To understand GPs’ views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer.Design & setting A qualitative semi-structured interview study with GPs from the East of England.Method GPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis.Results Three themes were identified across 23 interviews on GP views on the impact of: (1) changes in patient help-seeking behaviour on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how backlog in referrals would be managed.Conclusion This study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.

Original language	English
Article number	BJGPO.2021.0056
Journal	BJGP Open
Volume	5
Issue number	4
DOIs	https://doi.org/10.3399/BJGPO.2021.0056
Publication status	Published - 1 Aug 2021

Bibliographical note

Funding
This research was co-funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, PR-PRU-1217–21601. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The study was also supported by
the CanTest Collaborative funded by Cancer Research UK C8640/A23385, of which Fiona Walter is director, Richard Neal is associate director, Suzanne Scott is co-investigator, and Natalia Calanzani and Stephanie Honey are researchers. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Keywords

general practice
neoplasms
early diagnosis
coronavirus

UN SDGs

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

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Cite this

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title = "Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views",

abstract = "Background Early diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic.Aim To understand GPs{\textquoteright} views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer.Design & setting A qualitative semi-structured interview study with GPs from the East of England.Method GPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis.Results Three themes were identified across 23 interviews on GP views on the impact of: (1) changes in patient help-seeking behaviour on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how backlog in referrals would be managed.Conclusion This study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.",

keywords = "general practice, neoplasms, early diagnosis, coronavirus",

author = "Stephanie Archer and Natalia Calanzani and Stephanie Honey and Margaret Johnson and Richard Neal and Scott, {Suzanne E} and Walter, {Fiona M}",

note = "Funding This research was co-funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, PR-PRU-1217–21601. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The study was also supported by the CanTest Collaborative funded by Cancer Research UK C8640/A23385, of which Fiona Walter is director, Richard Neal is associate director, Suzanne Scott is co-investigator, and Natalia Calanzani and Stephanie Honey are researchers. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.",

year = "2021",

month = aug,

day = "1",

doi = "10.3399/BJGPO.2021.0056",

language = "English",

volume = "5",

journal = "BJGP Open",

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publisher = "Royal College of General Practitioners",

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T1 - Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

AU - Archer, Stephanie

AU - Calanzani, Natalia

AU - Honey, Stephanie

AU - Johnson, Margaret

AU - Neal, Richard

AU - Scott, Suzanne E

AU - Walter, Fiona M

N1 - Funding This research was co-funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, PR-PRU-1217–21601. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The study was also supported by the CanTest Collaborative funded by Cancer Research UK C8640/A23385, of which Fiona Walter is director, Richard Neal is associate director, Suzanne Scott is co-investigator, and Natalia Calanzani and Stephanie Honey are researchers. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

PY - 2021/8/1

Y1 - 2021/8/1

N2 - Background Early diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic.Aim To understand GPs’ views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer.Design & setting A qualitative semi-structured interview study with GPs from the East of England.Method GPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis.Results Three themes were identified across 23 interviews on GP views on the impact of: (1) changes in patient help-seeking behaviour on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how backlog in referrals would be managed.Conclusion This study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.

AB - Background Early diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic.Aim To understand GPs’ views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer.Design & setting A qualitative semi-structured interview study with GPs from the East of England.Method GPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis.Results Three themes were identified across 23 interviews on GP views on the impact of: (1) changes in patient help-seeking behaviour on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how backlog in referrals would be managed.Conclusion This study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.

KW - general practice

KW - neoplasms

KW - early diagnosis

KW - coronavirus

U2 - 10.3399/BJGPO.2021.0056

DO - 10.3399/BJGPO.2021.0056

M3 - Article

SN - 2398-3795

VL - 5

JO - BJGP Open

JF - BJGP Open

IS - 4

M1 - BJGPO.2021.0056

ER -

Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

Abstract

Bibliographical note

Keywords

UN SDGs

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Cite this