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.

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.

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, 112(S1), S50-S56. https://doi.org/10.1038/bjc.2015.42

• Journal Article Type: Article
• Online Publication Date: Mar 3, 2015
• Publication Date: Mar 31, 2015
• Deposit Date: Apr 25, 2019
• Publicly Available Date: Mar 23, 2021
• Journal: British Journal of Cancer
• Print ISSN: 0007-0920
• Electronic ISSN: 1532-1827
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 112
• Issue: S1
• Pages: S50-S56
• DOI: https://doi.org/10.1038/bjc.2015.42
• Keywords: Emergency presentation; Significant event; Primary care; Qualitative
• Public URL: https://hull-repository.worktribe.com/output/1646998
• Publisher URL: https://www.nature.com/articles/bjc201542
• Additional Information: First Online: 3 March 2015; : The authors declare no conflict of interest.