Hidden systems in primary care cancer detection: an embedded qualitative intervention development study

Area of Science:

• Primary Care Medicine
• Oncology
• Health Services Research

Background:

• UK cancer mortality rates exceed those in comparable high-income nations.
• Diagnostic delays within primary care contribute significantly to this disparity.
• Effective interventions require understanding the factors influencing GP diagnostic behavior.

Purpose of the Study:

• To investigate the beliefs and behaviors of general practitioners (GPs) regarding cancer diagnosis.
• To examine the role of general practice team systems and culture in cancer diagnosis.
• To inform the development of the 'Think Cancer!' intervention.

Main Methods:

• A qualitative embedded study conducted in primary care settings in Wales, UK.
• Utilized the COM-B (Capability, Opportunity, Motivation - Behaviour) and Theoretical Domains Framework (TDF) to guide the research.
• Data collected through semi-structured interviews with 20 GPs and four focus groups with practice teams, analyzed using framework analysis.

Main Results:

• Identified three key themes: referral considerations, external influences/constraints, and the impact of practice systems/culture.
• Revealed tensions between individual GP decision-making (Capability, Motivation) and external pressures (Opportunity), particularly from the primary-secondary care interface.
• Positive practice culture and supportive systems were found to mitigate diagnostic complexities and delays.

Conclusions:

• Understanding individual GP behaviors alongside practice systems and culture offers new insights into cancer diagnosis processes.
• Highlights the critical tension between individual GP decision-making and external pressures, impacting diagnostic timeliness.
• Provides a foundation for developing targeted interventions to improve cancer diagnosis in primary care.