Abstract
Prolonged diagnostic intervals may negatively affect the patient experience of subsequent cancer care, but evidence about this assertion is sparse. We analysed data from 73 462 respondents to two English Cancer Patient Experience Surveys to examine whether patients with three or more (3+) pre‐referral consultations were more likely to report negative experiences of subsequent care compared with patients with one or two consultations in respect of 12 a priori selected survey questions. For each of 12 experience items, logistic regression models were used, adjusting for prior consultation category, cancer site, socio‐demographic case‐mix and response tendency (to capture potential variation in critical response tendencies between individuals). There was strong evidence (P < 0.01 for all) that patients with 3+ pre‐referral consultations reported worse care experience for 10/12 questions, with adjusted odds ratios compared with patients with 1–2 consultations ranging from 1.10 (95% confidence intervals 1.03–1.17) to 1.68 (1.60–1.77), or between +1.8% and +10.6% greater percentage reporting a negative experience. Associations were stronger for processes involving primary as opposed to hospital care; and for evaluation than report items. Considering 1, 2, 3–4 and ‘5+’ pre‐referral consultations separately a ‘dose–response’ relationship was apparent. We conclude that there is a negative association between multiple pre‐diagnostic consultations with a general practitioner and the experience of subsequent cancer care.
Highlights
Most cancer patients are diagnosed after the onset of symptoms caused by their cancer, typically after presenting to a general practitioner (GP; Elliss-Brookes et al 2012)
We examined associations between the number of pre-diagnostic GP consultations before referral for specialist assessment and the evaluation of subsequent cancer care
Among 73 462 patients included in the initial analysis sample, 44 827 (61.0%) had seen their GP once or twice before referral and 13 280 (18.1%) had seen the GP three or more times, while in 15 355 (20.9%) patients, the diagnostic process did not involve prior consultation with a GP
Summary
Most cancer patients are diagnosed after the onset of symptoms caused by their cancer, typically after presenting to a general practitioner (GP; Elliss-Brookes et al 2012). Most such patients are referred promptly for specialist assessment, some experience multiple con- MENDONCA ET AL. Policy initiatives in several countries aim to shorten intervals from presentation to diagnosis (Department of Health, 2001; Olesen et al 2009; Prades et al 2011). Several considerations motivate such policies, including improving clinical outcomes and minimising the frequency of medico-legal complaints (Torring et al 2012; Wallace et al 2013). A recent systematic review on the association between diagnostic timeliness and cancer outcomes lamented the lack of evidence of the impact of delays on patient-reported outcomes and indicated ‘a dearth of studies reporting patient experience’ (Neal et al 2015)
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