Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

Abstract

BackgroundThe 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.AimTo examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance.Design and settingQualitative study in GP practices in one Northern English city.MethodIn-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.ResultsIn this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.ConclusionFailure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.

Factors affecting the decision to investigate older adults with potential cancer symptoms: a systematic review

“…A study of GPs found that most were aware that time constraints within consultations with older adults limited what could be discussed. 60 Two studies highlighted problems with policies such as ‘one appointment, one problem’, which may not suit an older patient demographic. 74 , 75 However, there was evidence that GPs considered the practicalities of older adults attending appointments, with one GP suggesting that older adults may find afternoon appointments easier.…”

“… 74 , 75 However, there was evidence that GPs considered the practicalities of older adults attending appointments, with one GP suggesting that older adults may find afternoon appointments easier. 60 …”

A qualitative exploration of women's perspectives and acceptability of including new cancer awareness information in all‐clear breast or cervical screening results

“…Sekhon et al ( 2017 ) highlights the centrality of self‐efficacy (an individual's confidence in their ability to perform the required behaviour) to the acceptability of an intervention. Previous findings (Jefferson et al, 2019 ) also identified difficulty booking a GP appointment as a barrier to early help‐seeking for suspected cancer symptoms. This suggests the need to examine the dynamics of patient‐provider communications while addressing the important elements that could facilitate or impede how ‘teachable moment’ is maximised in this context.…”

Causes, impacts and possible mitigation of non-attendance of appointments within the National Health Service: a literature review

“…Their negative connotations for the healthcare industry impact heavily on patients and service provision. Within this review numerous adverse outcomes were associated with DNAs, including hospital penalties, increased waiting times (Jefferson et al. , 2019; Sheridan et al.…”

“…, 2021). Jefferson et al. (2019) identifies several key factors, such as system flaws and doctor-patient communication, as core complications of practice factors in their qualitative study.…”