Alignment between the patient\u2019s cancer worry and the GP\u2019s cancer suspicion and the association with the interval between first symptom presentation and referral: a cross-sectional study in Denmark

Line Flytkjær Virgilsen,Henry Jensen,Peter Vedsted,Anette Fischer Pedersen,Gitte Stentebjerg Petersen

doi:10.1186/s12875-021-01480-2

Line Flytkjær Virgilsen, Henry Jensen + Show 3 more

Open Access

https://doi.org/10.1186/s12875-021-01480-2

Copy DOI

Abstract

BackgroundGeneral practitioners (GPs) have a key role in the diagnosis of cancer. It is crucial to identify factors influencing the decision to refer for suspected cancer. The aim of this study was to investigate the alignment between the patient’s cancer worry and the GP’s suspicion of cancer in the first clinical encounter and the association with the time interval from the first symptom presentation until the first referral to specialist care, i.e. the primary care interval (PCI).MethodThe study was performed as a cross-sectional study using survey data on patients diagnosed with incident cancer in 2010 or 2016 and their GPs in Denmark. We defined four alignment groups: 1) patient worry and GP suspicion, 2) GP suspicion only, 3) patient worry only, and 4) none of the two. A long PCI was defined as an interval longer than the 75th percentile.ResultsAmong the 3333 included patients, both patient worry and GP suspicion was seen in 39.5%, only GP suspicion was seen in 28.2%, only patient worry was seen in 13.6%, and neither patient worry nor GP suspicion was seen in 18.2%. The highest likelihood of long PCI was observed in group 4 (group 4 vs. group 1: PPR 3.99 (95% CI 3.34–4.75)), mostly pronounced for easy-to-diagnose cancer types.ConclusionMisalignment between the patient’s worry and the GP’s suspicion was common at the first cancer-related encounter. Importance should be given to the patient interview, due to a potential delayed GP referral among patients diagnosed with “easy-to-diagnose” cancer types presenting with unspecific symptoms.

Highlights

Cancer incidence is increasing in most western countries [1, 2]
Among the 3333 included patients, both patient worry and general practitioner (GP) suspicion was seen in 39.5%, only GP suspicion was seen in 28.2%, only patient worry was seen in 13.6%, and neither patient worry nor GP suspicion was seen in 18.2%
The highest likelihood of long primary care interval (PCI) was observed in group 4 (group 4 vs. group 1: PPR 3.99), mostly pronounced for easy-to-diagnose cancer types

Summary

Introduction

In healthcare systems relying on the GP to act as gatekeeper, the majority of patients with cancer initially present their symptoms and signs in general practice [7,8,9,10,11]. In these countries, the GP plays a central role in ensuring early diagnosis of cancer [4]. The time from the patient’s symptom presentation in general practice until the referral by the GP for further specialised diagnostic investigations, i.e. the primary care interval (PCI), is often short, with median intervals ranging from 0 to 20 days across cancer types (e.g. 14 days for lung cancer and 0 days for breast cancer) [12]. The aim of this study was to investigate the alignment between the patient’s cancer worry and the GP’s suspicion of cancer in the first clinical encounter and the association with the time interval from the first symptom presentation until the first referral to specialist care, i.e. the primary care interval (PCI)

Objectives

Methods

Results

Discussion

Conclusion