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BackgroundMost cancers are diagnosed following contact with primary care. Patients diagnosed with cancer often see their doctor multiple times with potentially relevant symptoms before being referred to see a specialist, suggesting missed opportunities during doctor-patient conversations.ObjectiveTo understand doctor-patient communication around the significance of persistent or new presenting problems and its potential impact on timely cancer diagnosis.Research designQualitative thematic analysis based on video recordings of doctor-patient consultations in primary care and follow-up interviews with patients and doctors. 80 video observations, 20 patient interviews and 7 doctor interviews across 7 general practices in England.ResultsWe found that timeliness of diagnosis may be adversely affected if doctors and patients do not come to an agreement about the presenting problem’s significance. ‘Disagreements’ may involve misaligned cognitive factors such as differences in medical knowledge between doctor and patient or misaligned emotional factors such as patients’ unexpressed fear of diagnostic procedures. Interviews suggested that conversations where the difference in views is either not recognised or stays unresolved may lead to unhelpful patient behaviour after the consultation (eg, non-attendance at specialist appointments), creating potential for diagnostic delay and patient harm.ConclusionsOur findings highlight how doctor-patient consultations can impact timely diagnosis when patients present with persistent or new problems. Misalignments were common and could go unnoticed, leaving gaps for potential to cause patient harm. These findings have implications for timely diagnosis of cancer and other serious disease because they highlight the complexity and fluidity of the consultation and the subsequent impact on the diagnostic process.

Invoking health benefits to promote climate-friendly household behavior has three unique advantages: (i) health co-benefits accrue directly to the acting individual, they are "private goods" rather than public ones; (ii) the evidence base and magnitude of health co-benefits is well-established; and (iii) the idea of a healthy lifestyle is well-engrained in public discourse, much more so than that of climate-friendly lifestyle. In previous research assessing the influence of information on health effects on people's motivation to adopt mitigation actions, health co-benefits for the individual were typically confounded with collective health cobenefits, for example from pollution reduction. The present research aims to overcome this limitation by providing information on individual health co-benefits that are unconditional on the actions of others (direct health co-benefits). We report effects of this kind of health information on stated preferences to adopt mitigation actions as well as on simulation-based carbon emission reductions in an experimental setting among 308 households in 4 mid-size case-study cities in 4 European high-income countries: France, Germany, Norway and Sweden. For each mitigation action from the sectors food, housing, and mobility, half of the sample received the amount of CO2equivalents (CO2-eq) saved and the financial costs or savings the respective action generated. The other half additionally received information on direct health co-benefits, where applicable. For households receiving information on direct health co-benefits, we find a higher mean willingness to adopt food and housing actions, and a greater proportion very willing to adopt one or more mitigation actions (OR 1.86, 95% CI 1.1, 3.12); and a greater simulated reduction in overall carbon footprint: difference in percent reduction-2.70%, (95% CI-5.34,-0.04) overall and-4.45%, (95% CI-8.26,-0.64) for food. Our study is the first to show that providing information on strictly unconditional, individual health co-benefits can motivate households in high-income countries to adopt mitigation actions.