Patient and practitioner views on cancer risk discussions in primary care: a qualitative study.

David N Blane,Sara Macdonald,Catherine A O'Donnell

doi:10.3399/bjgpo.2021.0108

Abstract

BackgroundIt is estimated that nearly 600 000 cancer cases in the UK could have been avoided in the past 5 years if people had healthier lifestyles, with the principle modifiable risk factors being smoking, obesity, alcohol consumption, and inactivity. There is growing interest in the use of cancer risk information in general practice to encourage lifestyle modification.AimTo explore the views and experiences of patients and practitioners in relation to cancer prevention and cancer risk discussions in general practice.Design & settingQualitative study among patients and practitioners in general practices in Glasgow, UK.MethodSemi-structured interviews were conducted with nine practitioners (five GPs and four practice nurses, recruited purposively from practices based on list size and deprivation status), and 13 patients (aged 30–60 years, with two or more specified comorbidities).ResultsCurrently, cancer risk discussions focus on smoking and cancer, with links between alcohol and/or obesity and cancer rarely made. There was support for the use of the personalised cancer risk tool as an additional resource in primary care. Practitioners felt practice nurses were best placed to use it. Use in planned appointments (for example, chronic disease reviews) was preferred over opportunistic use. Concerns were expressed, however, about generating anxiety, time constraints, and widening inequalities.ConclusionHealth behaviour change is complex and the provision of information alone is unlikely to have significant effects. Personalised risk tools may have a role, but important concerns about their use remain, particularly in areas of socioeconomic disadvantage.

Highlights

In the UK, nearly 600,000 cancer cases could have been avoided in the last five years if people had healthier lifestyles, with the principle modifiable risk factors being smoking, obesity, alcohol consumption and physical inactivity.[1]
Currently, cancer risk discussions focus on smoking and cancer, with links between alcohol/obesity and cancer rarely made
Primary care can help prevent cancer by supporting health behaviour change related to these risk factors,[2] utilising its strengths of contact, coverage, co-ordination and continuity.[3]

Summary

Introduction

In the UK, nearly 600,000 cancer cases could have been avoided in the last five years if people had healthier lifestyles, with the principle modifiable risk factors being smoking, obesity, alcohol consumption and physical inactivity.[1]. Brief interventions by GPs can support smoking cessation,[5] problem drinking[6] and engagement with weight management,[7] and recent interventions have attempted to tackle multiple health behaviours,[8] recognising the common clustering of risk factors, in deprived areas.[9] previous research has identified that barriers to behaviour change operate at patient, practitioner and system levels.[10,11] Future intervention development needs to account for both individual and structural factors This is important for cancer prevention, as socio-economic differences in cancer incidence are well documented,[12] in part due to higher prevalence of unhealthy behaviours in more deprived areas,[13] and due to wider structural inequalities.[14]. There is growing interest in the use of cancer risk information in general practice to encourage lifestyle modification

Objectives

Results

Conclusion