Physician perspectives on delays in cancer diagnosis in Alberta: a qualitative study

Abstract

Background: Delays in cancer diagnosis have been associated with reduced survival, decreased quality of life after treatment, and suboptimal patient experience. The objective of the study was to explore the perspectives of a group of family physicians and other specialists regarding potentially avoidable delays in diagnosing cancer, and approaches that may help expedite the process. Methods:We conducted a qualitative study using interviews with physicians practising in primary and outpatient care settings in Alberta between July and September 2019. We recruited family physicians and specialists who were in a position to discuss delays in cancer diagnosis by email via the Cancer Strategic Clinical Network and the Alberta Medical Association. We conducted semistructured interviews over the phone, and analyzed data using thematic analysis.Results: Eleven family physicians and 22 other specialists (including 7 surgeons or surgical oncologists, 3 pathologists, 3 radiologists, 2 emergency physicians and 2 hematologists) participated in interviews; 22 were male (66.7%). We identified 4 main themes describing 9 factors contributing to potentially avoidable delays in diagnosis, namely the nature of primary care, initial presentation, investigation, and specialist advice and referral. We also identified 1 theme describing 3 suggestions for improvement, including system integration, standardized care pathways and a centralized advice, triage and referral support service for family physicians.Interpretation: These findings suggest the need for enhanced support for family physicians, and better integration of primary and specialty care before cancer diagnosis. A multifaceted and coordinated approach to streamlining cancer diagnosis is required, with the goals of enhancing patient outcomes, reducing physician frustration and optimizing efficiency.

Using care pathways for cancer diagnosis in primary care: a qualitative study to understand family physicians’ mental models

“…In alignment with current discussions on suboptimal care continuity and inconsistent collaboration between family physicians or specialists, 5 , 9 , 48 , 49 our findings emphasize the importance of pathways, while also suggesting the need for additional improved supports for family physicians. A previous study by this team 1 reported that family physicians and cancer specialists supported the implementation of a centralized service where primary and specialist physicians converge in their roles. Pathways, low-risk guides and other initiatives, such as rapid access clinics 50 , 51 and specialty teleconsultation systems, 15 could be considered.…”

“…Interview guides were developed by the research team, which included a family physician and 2 allied health professionals, and based on practice expertise and previous work in the area. 1 , 18 , 33 , 34 In addition, we pilot-tested the interview guide with an external family physician. Interviews were conducted by an interviewer and a note-taker, both members of the AMA Accelerating Change Transformation Team (AMA-ACTT) trained in cognitive task analysis.…”

“…In Canada, the process of obtaining a cancer diagnosis after first suspicion of a problem can be fraught with delay, 1 – 5 which has been associated with shorter survival, decreased quality of life posttreatment and sub-optimal patient experience. 2 , 6 Delays may be caused by various factors related to the characteristics of cancer, the patient and the fragmented health care system.…”

“… 5 , 7 , 8 There is a set of standard tests and steps required to get to diagnosis, and the coordination of these mostly rests in the hands of family physicians. 1 , 5 , 9 …”

Improving colorectal cancer in Alberta, Canada: A qualitative study of patients and close contacts’ perceptions on diagnosis following an emergency department presentation

“…We conducted in-depth, semi-structured interviews. Two authors (APB and AW) developed the interview guides based on the literature, insights from previous studies examining perspectives of both patient and healthcare providers (31,32), and feedback received from two patient advisors. The interview topics are presented in Table 1.…”