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, 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 journal › Article › peer-review

1 Citation (Scopus)

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
Article number	29
Number of pages	12
Journal	BJGP Open
Volume	2023
Early online date	28 Jun 2023
DOIs	https://doi.org/10.3399/BJGPO.2023.0029
Publication status	Published - 19 Sept 2023

Bibliographical note

Funding
The Swedish application for ethical approval was funded by the Jämtland Cancer and Nursing Foundation. The study had no other external funding

Data Availability Statement

To avoid the risk of identification of individual participants or patients, the datasets
generated and analysed during the current study are not publicly available. However, they are available (with any identifying information redacted) from the corresponding author

Keywords

Primary Health Care
Primary Care Physician
Cancer
Europe
Diagnostic Errors
Qualitative Research

UN SDGs

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

Access to Document

10.3399/BJGPO.2023.0029Licence: CC BY

Hajdarevic_etak_BJGPO_Why_Do_European_Primary_VOR
This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)
Final published version, 1.04 MBLicence: CC BY

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, 2023, Article 29. https://doi.org/10.3399/BJGPO.2023.0029

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, vol. 2023, 29. 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.",

keywords = "Primary Health Care, Primary Care Physician, Cancer, Europe, Diagnostic Errors, Qualitative Research",

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",

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doi = "10.3399/BJGPO.2023.0029",

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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

N1 - Funding The Swedish application for ethical approval was funded by the Jämtland Cancer and Nursing Foundation. The study had no other external funding

PY - 2023/9/19

Y1 - 2023/9/19

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.

KW - Primary Health Care

KW - Primary Care Physician

KW - Cancer

KW - Europe

KW - Diagnostic Errors

KW - Qualitative Research

U2 - 10.3399/BJGPO.2023.0029

DO - 10.3399/BJGPO.2023.0029

M3 - Article

C2 - 37380218

SN - 2398-3795

VL - 2023

JO - BJGP Open

JF - BJGP Open

M1 - 29

ER -