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Understanding diagnosis of lung cancer in primary care: qualitative synthesis of significant event audit reports

Mitchell, Elizabeth D.; Rubin, Greg; Macleod, Una

Authors

Elizabeth D. Mitchell

Greg Rubin



Abstract

Background Most lung cancers present symptomatically, but the pathway to diagnosis in primary care can be complex and is poorly understood. Significant event audit (SEA) is a quality improvement technique widely used in UK general practice. Aim To gain insights into the diagnostic process for lung cancer, drawn from analysis of SEA documents. Design and setting Qualitative analysis of SEAs from 92 general practices in the North of England Cancer Network. Method Participating practices were provided with a standardised electronic template and asked to undertake a significant event audit related to the most recent diagnosis of lung cancer in the practice, even if that patient had since died. Reported accounts for 132 diagnoses were analysed using a modified framework approach. Results Most SEAs demonstrated timely recognition and referral. Where this had taken longer, there were often reasonable explanations, including: chest X-rays reported as normal or with benign findings; patient-mediated factors, such as delay in re-presenting or declining earlier referral; and presentation complicated by comorbidity. Some opportunities for earlier referral were also found. Lessons drawn from these events included limitations of chest X-ray as a diagnostic tool, the need for vigilance in patients with existing morbidity, and the importance of `safety-netting'. Conclusion Qualitative synthesis of SEAs offered considerable value in understanding circumstances surrounding the diagnostic process for lung cancer in primary care. The most common presentation was with cough or other symptoms indicative of infection, and it is by understanding more about these patients in particular that most can be gained.

Citation

Mitchell, E. D., Rubin, G., & Macleod, U. (2013). Understanding diagnosis of lung cancer in primary care: qualitative synthesis of significant event audit reports. The British journal of general practice : the journal of the Royal College of General Practitioners, 63(606), (e37-e46). doi:10.3399/bjgp13X660760. ISSN 0960-1643

Journal Article Type Article
Publication Date 2013-01
Journal British Journal of General Practice
Print ISSN 0960-1643
Electronic ISSN 1478-5242
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Volume 63
Issue 606
Pages e37-e46
DOI https://doi.org/10.3399/bjgp13X660760
Keywords Family Practice
Public URL https://hull-repository.worktribe.com/output/429132
Publisher URL https://bjgp.org/content/63/606/e37