Characteristics of Optimal Cancer Referrals Made by Primary Care Clinicians: Scoping Review

BackgroundIn England, over 2 million patients are referred each year on urgent pathways to investigate suspected cancer. The content and quality of referrals have often been audited, but there is no consensus on what should be included in a referral to optimise diagnostic outcomes.AimTo identify and describe the characteristics of referral letters for suspected cancer from primary to secondary care that may optimise diagnostic outcomes.MethodThe scoping review employed the methodology developed by Arksey and O'Malley in 2005 and further expanded by Levac and Colquhoun 2010. We searched PubMed, Embase, and PsycINFO to identify relevant studies in English Language published between 2000 and 2023. All findings were reported according to PRISMA guidelines for scoping reviews.ResultsOf 3463 identified records, only thirteen met the inclusion criteria, employing qualitative and mixed methods, as well as retrospective audits of referrals. The studies noted that symptom information such as duration, appearance, and descriptive qualities was often missing. There was limited evidence suggesting that the inclusion of clinical examination findings, test information, and the motivation of the referring clinician were beneficial. Evidence relating to the benefits of guidelines and template referral forms was mixed. There was a paucity of research linking referral content to patient diagnostic outcomes.ConclusionDespite a small number of studies retrieved, there was broad consensus about the benefit of conveying detailed information in referrals for suspected cancer, particularly with respect to comprehensive symptom description and relevant tests and clinical examinations. Further research linking referral quality to diagnostic outcomes would be beneficial to drive improvement to diagnostic outcomes.