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Quarter of patients need 3+ GP visits before cancer test referral

But more than 3 trips sets scene for greater dissatisfaction with overall care quality

Caroline White

Friday, 31 July 2015

Almost a quarter of people diagnosed with cancer through their GP were seen three or more times by their family doctor before they were referred for tests, finds research* published in the European Journal of Cancer Care today.

But if it takes more than three trips to the GP to be referred, patients are more likely to be dissatisfied with their overall care, including that provided by the doctors and nurses who go on to treat and monitor them, the findings show.

The researchers from University College London and the University of Cambridge analysed survey data from more than 70,000 responses to two English Cancer Patient Experience Surveys (2012 and 2013).

Of the nearly 60,000 survey respondents diagnosed through their GP, almost 13,300 (23%) had been seen three or more times before being referred for cancer tests.

Almost four out of 10 of those who had experienced referral delays were dissatisfied with the support they received from their GP and nurses compared with 28% of those referred after one or two GP visits.

Overall, patients who had seen their GP three or more times before being referred were more likely to report negative experiences across 10 of 12 different aspects of their care.

For example, 18% of these patients were dissatisfied with the way they were told they had cancer, compared with 14% of those referred after fewer visits.

And 40% were dissatisfied with how hospital staff and GPs had worked with each other to provide the best possible care, compared with one in three of those referred promptly.

Similarly there was also an increase from 10% to 12% among those who suspected information may have been deliberately withheld from them during treatment. And a rise from 28% to 32% among patients who said they lacked confidence and trust in the ward nurses.

Study author Dr Georgios Lyratzopoulos, a Cancer Research UK scientist at UCL, said: “This research shows that first impressions go a long way in determining how cancer patients view their experience of cancer treatment. A negative experience of diagnosis can trigger loss of confidence in their care throughout the cancer journey.”

But he said that delays were not always easy to avoid. “When they occur, diagnostic delays are largely due to cancer symptoms being extremely hard to distinguish from other diseases, combined with a lack of accurate and easy-to-use tests. New diagnostic tools to help doctors decide which patients need referring are vital to improve the care experience for even more cancer patients,” he emphasised.

Dr Richard Roope, Cancer Research UK’s GP expert, said: “It’s important we now step up efforts to ensure potential cancer symptoms can be investigated promptly, such as through the new NICE referral guidelines launched last month to give GPs more freedom to quickly refer patients with worrying symptoms. This will hopefully contribute to improving the patient experience, one of the six strategic priorities recommended by the UK’s Cancer Task Force last week.”

Sara Hiom, director of early diagnosis at Cancer Research UK, said: “This is the first time we’ve had direct feedback from patients on such a large scale to show how the timeliness of their diagnosis colours their experience of the care they later receive.

“It’s another good reason to highlight the importance of diagnosing cancer as quickly as possible, not just to give patients the best chances of survival, but also to improve their experience of the care they receive throughout their cancer journey.”

* S.C. Mendonca, et al. Pre-referral general practitioner consultations and subsequent experience of cancer care: evidence from the English Cancer Patient Experience Survey. European Journal of Cancer Care. Article first published online: 30 JUL 2015. DOI: 10.1111/ecc.12353

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