Acceptability, understanding and experience of diagnostic tests for prostate cancer: a qualitative study with GPs

Conference:

2020 SW SAPC Bristol

Talk Code:

1B.1

Presenter:

Samuel W D Merriel

Twitter:

@sammerriel

Co-authors:

Dr Alice Forster, Dr Steph Archer, Mr David Eldred-Evans, Mr John McGrath, Prof Hashim Ahmed, Prof Willie Hamilton, Dr Fiona Walter

Author institutions:

University of Exeter, University College London, University of Cambridge, Imperial College Healthcare NHS Trust, Royal Devon & Exeter Hospital, Imperial College London, University of Exeter, University of Cambridge

Problem

Multiparametric MRI (mpMRI) is a new diagnostic test for prostate cancer, and is now recommended by NICE prior to prostate biopsy. Diagnostic accuracy studies show mpMRI can improve biopsy accuracy and avoid potentially unnecessary biopsies, but other important aspects of implementing mpMRI as a new diagnostic test have not been examined. There are no studies assessing acceptability of mpMRI for prostate cancer with any theoretical underpinning. There are very few studies exploring GP’s understanding of diagnostic tests for prostate cancer. The aim of this study is to understand, from the perspective of GPs, the acceptability of mpMRI as a diagnostic test for prostate cancer.

Approach

This qualitative study employed semi-structured interviews with GPs who have referred men with suspected prostate cancer for further investigation in the last 12 months. GPs were recruited via the NIHR Clinical Research Network in South-West England and London. Interviews were conducted in-person or via telephone, and all were conducted by SM. They were audio recorded, and transcribed verbatim. A thematic analysis approach has been taken, both inductively by generating codes and themes from the data and deductively using Sekhon’s Theoretical Framework of Acceptability (TFA). The analysis team (SM, FW, and SA) discussed and refined the codes and themes to produce a thematic map, based on the early interviews. This study has ethical approval from the NHS Health Research Authority and the NHS South West – Frenchay Research Ethics Committee.

Findings

11 GPs have been interviewed, with a spread of age (38-46 years) and gender (6 female). All interviews have been conducted, recorded and transcribed. Early analysis found there was a range of views regarding the potential for GPs to utilise mpMRI in the diagnosis of prostate cancer in primary care; some GPs felt it should remain a secondary care test whilst others could see GPs using it in the future. GPs raised some concerns about the cost and availability of mpMRI. Further analysis of the interviews, and application of Sekhon’s TFA will be conducted prior to SW SAPC.

Consequences

The new NICE recommendations do not specify whether mpMRI should be performed in primary or secondary care. Given the potential to reduce unnecessary prostate biopsies and the apparent acceptability of mpMRI to patients and clinicians, mpMRI could one day be used in primary care in the assessment of men with possible prostate cancer to reduce urgent urology referrals and avoid prostate biopsy complications. Financial, resource, and workforce implications for the NHS would need to be considered prior to GP access to mpMRI.

Submitted by:

Sam Merriel

Funding acknowledgement:

SM is supported by the CanTest Collaborative, which is funded by Cancer Research UK [C8640/A23385]. FMW and WH are directors of the CanTest Collaborative.