Table 3. Recommended language and suggested language to avoid based on verbatim examples from our dataset
ScenarioRecommended communicationVerbatim examples of recommended communicationSuggested language to avoidVerbatim examples of language to avoid
GP decides patient is in need of a referral to the urgent suspected cancer referral pathwayExplain 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 pathwayExplain why the urgent suspected cancer pathway is being usedI 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 anxietyUse 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 cancerExplain 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 toolI think it’s very unlikely having examined you that there’s something worrying or sinister cancer-like going on’ [GP64]