Exploring General Practitioners' Referral Behaviour to a Rapid Diagnostic Centre for Non-Specific Cancer Symptoms: A Qualitative Study

Problem

Determining whether patient symptoms might be attributable to cancer can be associated with uncertainty for GPs; especially when patients present with non-specific symptoms (NSS). Rapid Diagnostic Centres (RDC) for NSS where cancer is suspected have been introduced using different approaches across NHS Trusts, as a new cancer diagnostic pathway. The NHS Trust in this study focused on a suite of pre-determined tests, ordered, and reviewed by GPs followed by potential referral to a RDC located within secondary care. Little is known about GPs’ experiences and perceptions of the RDC pathway, which is the focus of this study.

Approach

A qualitative study was undertaken within one NHS Trust to explore GP experiences of using this diagnostic pathway. GPs from city, rural and coastal practices were interviewed for the study. Interview data was analysed thematically.

Findings

GPs confirmed the challenges inherent in determining when NSS might signal cancer. The initial suite of tests helped determine when onward referral was warranted and when ‘watch and wait’ or local management were appropriate. The pathway was felt to offer faster access to testing, diagnosis and treatment; gave GPs a referral route when patients were not eligible for established two-week wait pathways and reassured GPs and patients that appropriate action was being taken to investigate symptoms. Recent colorectal pathway changes have required patients to have a positive fit test. A positive outcome of the RDC pathway was that it provided an alternative route for fit negative patients where cancer was suspected. The RDC reported diagnosing a large range of cancers since inception, as well as a large number of other hard to diagnose conditions. There was evidence from the interviews that not all GPs knew about the pathway and that information about changes introduced had not been remembered by all. While patient views were not sought, GPs perceived they welcomed the referral and prompt investigation with most attending, and that non-cancer diagnoses provided relief to patients. However, there was evidence that the time and costs of travel and clinic attendance were barriers for some in rural/ coastal areas. The majority of GPs expressed satisfaction with the RDC pathway and welcomed access to it.

Consequences

The RDC diagnostic pathway was introduced to fill a gap where patients present with non specific symptoms that could be cancer. It assisted GPs when they lacked an appropriate referral pathway for such patients and facilitated the diagnosis of cancer and other significant conditions. This underscores the value of continuing this diagnostic pathway. Ongoing efforts to ensure GPs are aware of the pathway and changes are needed. Patients reportedly valued referral to the RDC pathway; however, some barriers to attendance were highlighted. Research incorporating the patient perspective would provide a richer understanding of their experiences.