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Tables
Characteristic Patients (n = 23) Doctors (n = 9) Mean age, years (minimum–maximum) 67 (50–88) 47 (32–59) Gender, n (%) Male 14 (61) 6 (67) Female 9 (39) 3 (33) Total 23 9 Ethnic origin, n (%) White/White British/White Other 21 (91) 8 (89) Asian/Asian British 1 (4) 1 (11) Black/African/Caribbean/Black British 1 (4) 0 Other ethnic group 0 0 Highest education qualification, n (%) Degree or higher degree 5 n/a Below degree level 11 n/a No formal qualification 6 n/a Information not provided 1 0 Mean years since accreditation as a doctor (minimum–maximum) n/a 14 (2–30) Accredited doctor trainer, n (%) n/a 6 (67) NG12 guidance 1.14 patient information and support GP communication strategies 1.14.3 Explain to people who are being referred with suspected cancer that they are being referred to a cancer service.
Reassure them, as appropriate, that most people referred will not have a diagnosis of cancer, and discuss alternative diagnoses with them [2015]In n = 8 consultations, GPs told their patient that they were referring the patient to a cancer service. In n = 4 consultations, no mention of a cancer service was made.
In the 8 consultations where GPs did inform their patient that they were referring them to a cancer service, GPs used reassurance.
In n = 6 consultations, GPs offered patients both cancer and alternative diagnoses (four of which were initiated by the GP and two by patients). In n = 2 consultations, the GP mentioned only the cancer diagnosis, in n = 3 consultations there was symptom-directed language only and in n = 1 consultations only the alternative diagnosis was mentioned.1.14.5 The information given to people with suspected cancer and their families and/or carers should cover, among other issues: • where the person is being referred to
• how long they will have to wait for the appointment
• how to obtain further information about the type of cancer suspected or help before the specialist appointment
• what to expect from the service the person will be attending
• what type of tests may be carried out, and what will happen during diagnostic procedures
• how long it will take to get a diagnosis or test results
• whether they can take someone with them to the appointment
• who to contact if they do not receive confirmation of an appointment
• other sources of support [2015]
In this dataset, in only one patient’s case did the GP not mention that the patient would be seen by a specialist within 2 weeks. In seven patients’ cases GPs informed patients where they would be seen (that is, the name of the hospital or clinic)
In four patients’ cases, GPs spoke about the type of tests that might be carried out. No GP spoke about sources of support for the patient while they were waiting for the referral, whether the patient could take anyone with them, how to obtain further information and help and what to expect from the serviceNICE = National Institute for Health and Care Excellence.
- Table 3. Recommended language and suggested language to avoid based on verbatim examples from our dataset
Scenario Recommended communication Verbatim examples of recommended communication Suggested language to avoid Verbatim examples of language to avoid GP decides patient is in need of a referral to the urgent suspected cancer referral pathway Explain that the patient is being referred on the urgent suspected cancer pathway ’… so I think we have to refer you as an urgent suspected cancer because you’ve got sort of more than a month’s history of difficulty swallowing …’ [GP204] Avoid using solely symptom-directed language ’As far as this is concerned [pointing to left temple], I’ll contact the skin people, they’ll be at [name of hospital], I think they’ll see you … in the next couple of weeks, just to be absolutely certain what’s going ok.’ [GP284] GP wants to explain why they are making a referral on the urgent suspected cancer referral pathway Explain why the urgent suspected cancer pathway is being used ’I think it’s worth referring you for further tests ‘cause you’re losing the weight.’ [GP232] Avoid stating that the only reason the GP wants a specialist appointment is to check out symptoms ’And what I’d suggest I’d do is if I write down to [name of clinic], get the bowels checked out because obviously they know you pretty well, don’t they?’ [GP255] GP wants to explain the 2-week-wait as a way to assuage patient anxiety Use the reassurance of being seen quickly by a specialist ’… you’ll be seen within 2 weeks, so really quite quickly.’ [GP248] Avoid intimating that the only reason that they are referring the patient is to get a rapid specialist opinion ’It goes to the suspected cancer clinic but it doesn’t mean that you got cancer, it’s just a quicker way of getting the test done.’ [GP232] GP wants to explain the likelihood of the symptoms being cancer Explain that most people referred will not go on to receive a cancer diagnosis ’ ... we refer people for suspected cancer and it’s even if there’s only about a 2% chance it might actually be cancer we’d rather refer 98 and it’s normal than miss those two … ‘ [GP264] Avoid specifying the individual’s risk unless using a risk tool ’I think it’s very unlikely having examined you that there’s something worrying or sinister cancer-like going on’ [GP64]
Supplementary Data
- Rus_10.3399BJGPO.2024.0115_supp.docx -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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How GPs communicate the urgent suspected cancer referral pathway to patients: a qualitative study of GP–patient consultations
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