TY - JOUR
T1 - Non-attendance at urgent referral appointments for suspected cancer
T2 - a qualitative study to gain understanding from patients and GPs
AU - Jefferson, Laura
AU - Atkin, Karl
AU - Sheridan, Rebecca
AU - Oliver, Steven
AU - Macleod, Una
AU - Hall, Geoff
AU - Forbes, Sarah
AU - Green, Trish
AU - Allgar, Victoria
AU - Knapp, Peter
N1 - © British Journal of General Practice 2019.
PY - 2019/12
Y1 - 2019/12
N2 - BACKGROUND: The 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.AIM: To examine how interpersonal, communication, social, and organisational factors influence a patient's non-attendance.DESIGN AND SETTING: Qualitative study in GP practices in one Northern English city.METHOD: In-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.RESULTS: In 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.CONCLUSION: Failure 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.
AB - BACKGROUND: The 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.AIM: To examine how interpersonal, communication, social, and organisational factors influence a patient's non-attendance.DESIGN AND SETTING: Qualitative study in GP practices in one Northern English city.METHOD: In-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.RESULTS: In 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.CONCLUSION: Failure 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.
KW - cancer
KW - COMMUNICATION
KW - Diagnosis
KW - no-show
KW - Patients
KW - Primary health care
KW - Socioeconomic factors
UR - http://www.scopus.com/inward/record.url?scp=85075813726&partnerID=8YFLogxK
U2 - 10.3399/bjgp19X706625
DO - 10.3399/bjgp19X706625
M3 - Article
C2 - 31748378
SN - 0960-1643
VL - 69
SP - e850-e859
JO - The British journal of general practice : the journal of the Royal College of General Practitioners
JF - The British journal of general practice : the journal of the Royal College of General Practitioners
IS - 689
ER -