Abstract
BackgroundThe study sought to evaluate the impact of a Rapid Diagnostic Clinic (RDC) service designed to improve general practitioner (GP) referral processes for patients who do not meet existing referral criteria yet present with vague - but potentially concerning - symptoms of cancer. We sought to investigate how well the RDC has performed in the views of local GPs and patients, and through analysis of its activity and performance in the first two years of operation.MethodsThe study setting was a single, hospital-based RDC clinic in a University Health Board in South Wales. We used a mixed-method process evaluation study, including routinely collected activity and diagnosis data. All GPs were invited to participate in an online survey (34/165 responded), and a smaller group (n = 8) were interviewed individually. Two focus groups with patients and their carers (n = 7) provided in-depth personal accounts of their experiences.ResultsThe focus groups revealed high rates of patient satisfaction with the RDC. GPs were also overwhelmingly positive about the value of the RDC to their practice. There were 574 clinic attendances between July 2017 and March 2019; the mean age of attendees was 68, 57% were female, and approximately 30% had three or more vague symptoms. Of those attending, we estimated between 42 to 71 (7.3 and 12.3%) received preliminary cancer diagnoses. Median time from GP referral to RDC appointment was 12 days; from GP referral to cancer diagnosis was 34 days. Overall, 73% of RDC patients received either a new diagnosis (suspected cancer 23.2%, non-cancer 35.9%) or an onward referral to secondary care for further investigation with no new diagnosis (13.9%), and 27% were referred to primary care with no new diagnosis.ConclusionsThe RDC appears to enable a good patient experience in cancer diagnosis. Patients are seen in timely fashion, and the service is highly regarded by them, their carers, and referring GPs. Although too early to draw conclusions about long-term patient outcomes, there are strong indications to suggest that this model of service provision can set higher standards for a strongly patient-centred service.
Highlights
The study sought to evaluate the impact of a Rapid Diagnostic Clinic (RDC) service designed to improve general practitioner (GP) referral processes for patients who do not meet existing referral criteria yet present with vague - but potentially concerning - symptoms of cancer
The speed of the referral process was highly valued as it lessened ‘worry time’ for patients and carers. All said they had no hesitation in recommending the RDC to any friends or family with similar symptomatic conditions to proactively seek a referral to the RDC service
Results from the GP interviews demonstrated overwhelming support for the RDC and the value it provided for clinicians and patients
Summary
The study sought to evaluate the impact of a Rapid Diagnostic Clinic (RDC) service designed to improve general practitioner (GP) referral processes for patients who do not meet existing referral criteria yet present with vague - but potentially concerning - symptoms of cancer. In response to this variation, urgent suspected cancer pathways for assessment of patients with symptoms that raise suspicion of cancer in a specific site have been in place for a number of years, for example, for suspected colorectal, lung, ovarian and prostate cancer [2]. Many of the patients who go on to receive a diagnosis of cancer initially present with non-specific or vague symptoms such as fatigue, loss of appetite or unexplained weight loss. These are symptoms which warrant investigation [4], they do not readily align with referral criteria for many cancers when presented in isolation and in the absence of a specific lump, bleeding or more physically alarming symptom. In the absence of specific pathways for this group of patients [5], unnecessary and unacceptable delays in diagnosis can occur [6]
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