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The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports

Mitchell, E D; Rubin, G; Merriman, L; Macleod, U

Authors

E D Mitchell

G Rubin

L Merriman



Abstract

Background:
Patients diagnosed with cancer in the context of an emergency presentation (EP) have poorer outcomes. It is often assumed that such patients present to the emergency department without consulting their general practitioner (GP). Little work has been done to identify primary care involvement before hospital attendance.

Methods:
Participating primary care practices completed a significant event audit (SEA) report for the last patient diagnosed with cancer as a result of an EP. Accounts were synthesised and a qualitative approach to analysis undertaken.

Results:
SEAs for 222 patients were analysed. A range of cancers were included, the most common being lung (32.4%) and upper gastrointestinal (19.8%). In most cases, patients had contact with their practice before diagnosis, primarily in the period immediately before admission. In only eight cases had there been no input from primary care. Accounts of protracted primary care contact generally demonstrated complexity, often related to comorbidity, patient-mediated factors or reassurance provided by negative investigations. Learning points identified by practices centred on the themes of presentation and diagnosis, consultation and safety-netting, communication and system issues, patient factors and referral guidelines.

Conclusions:
There is extensive primary care input into patients whose diagnosis results from EP, and for the most part potential ‘delay’ in referral can be reasonably explained by the complexity of the presentation or by coexisting patient factors.

Journal Article Type Article
Publication Date Mar 31, 2015
Journal British Journal of Cancer
Print ISSN 0007-0920
Electronic ISSN 1532-1827
Publisher Cancer Research UK
Peer Reviewed Peer Reviewed
Volume 112
Issue S1
Pages S50-S56
APA6 Citation Mitchell, E. D., Rubin, G., Merriman, L., & Macleod, U. (2015). The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports. The British journal of cancer / Cancer Research Campaign, 112(S1), S50-S56. https://doi.org/10.1038/bjc.2015.42
DOI https://doi.org/10.1038/bjc.2015.42
Keywords Cancer Research; Oncology
Publisher URL https://www.nature.com/articles/bjc201542
Additional Information First Online: 3 March 2015; : The authors declare no conflict of interest.
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