What are the individual beliefs and behaviours amongst GPs, and formal and informal practice team systems and norms when identifying, investigating and referring patients with cancer signs and symptoms?

Problem

Cancer outcomes in the UK are worse than many similar countries. One contributory factor for this is the length of the ‘primary care interval’ (the time form first presentation of a ‘cancer symptom’ to onward referral or diagnostic investigation). Part of the solution therefore is to develop and evaluate behaviour change interventions to expedite the diagnosis of symptomatic cancer. The Wales Interventions and Cancer Knowledge about Early Diagnosis (‘WICKED’) programme is designed to develop and evaluate such interventions. It comprises several inter-connected work packages including the qualitative component that is reported here. The aim of this qualitative study is to elicit and describe: a) individual beliefs and behaviours amongst GPs, and b) formal and informal practice team systems and norms when identifying, investigating and referring patients with cancer signs and symptoms.

Approach

Twenty qualitative telephone interviews were conducted with GPs to explore individual beliefs and behaviours. Four focus groups were held with practice teams to explore practice systems and norms. Purposive sampling (rurality, deprivation, years since qualification, training practice status) was conducted to identify a range of participants. Data were analysed using the Framework approach, underpinned by the Behaviour Change Wheel.

Findings

Preliminary analysis of six interviews suggests that GPs find difficulty in referring patients with vague symptoms and describe sometimes practising over-defensive medicine to avoid feelings of blame or guilt. They explained feeling that they want their referral behaviour to align with others, to ‘fit’ with expectations in secondary care, and to feel trusted. GPs cited decision-making support and reassurance from primary and secondary care colleagues as a valuable aspect of day-to-day referral behaviour. Key areas emerging from the review work have been explored during the focus groups and include ‘communication’, ‘significant event analysis’, ‘safety netting’, ‘tests and investigations’. The results will be presented in full at the conference.

Consequences

This qualitative study will provide an in-depth understanding of the influences on early cancer diagnosis by GPs and practice teams in primary care. The findings will be used to inform the development and evaluation of a behaviour change intervention to expedite the diagnosis of symptomatic cancer.