Article Figures & Data
Figures
- Figure 1.
Flow diagram of search strategy for Aim 1.
- Figure 2.
Flow diagram of search strategy for Aim 2.
- Figure 3.
Logic model — patient involvement in diagnosing cancer in primary care. HCP = healthcare professional.
Tables
Author/year Type of cancer Country Article type Aim — text taken from paper Study design Setting Population characteristics Banks et al, 201433 Lung, pancreatic, colorectal England Research To establish the likelihood that individuals would choose to be tested for cancer at various levels of risk Vignette-based study 26 general practices across England 3469 individuals (≥40 years) Birt et al, 201434 Lung England Research To understand the symptom evaluation, or ‘appraisal’, and help-seeking decisions of patients with symptoms suggestive of lung cancer Prospective cohort face-to-face interview study Specialist respiratory clinics in secondary and tertiary care, England 35 patients (male = 20, female = 15; mean age 58.5 years; range 41–88 years; 17 with lung cancer, 18 with other conditions) Black et al, 201535 Colorectal, upper GI, lung, haematological, head and neck, gynaecological, unknown primary England Research To capture in detail the experiences of patients whose cancer was diagnosed following an ED visit to understand how emergency presentations arise, and identify where there is scope to improve outcomes Interview 11 EDs across nine acute NHS trusts (participants came from seven NHS trusts) 27 patients (male = 15, female = 12; median age 59 years; range 18–92 years) Evans et al, 200636 Ovarian UK Research 1) To use accounts of provider delay from a sample of British women with ovarian cancer to enhance Andersen’s model of total patient delay; 2) To suggest what GPs might do to minimise delays Semi-structured interviews with a maximum variation sample Recruitment through GPs, clinicians, support organisations, and personal contacts 43 women diagnosed with ovarian cancer (mean age 54 years; range 33–80 years) Jensen et al, 201437 Bladder, breast, colon, lung, malignant melanoma, others, ovarian, prostate, rectal, uterus Denmark Research 1) To describe the prevalence and types of QDs that arose during the diagnostic pathway for Danish patients with cancer as assessed by the GPs; 2) To analyse the associations between QDs and the type of cancer; between QDs and the GP interpretation of presenting symptoms; 3) Impact of QDs on diagnostic interval length Nationwide retrospective cohort questionnaire-based study 1446 GPs identified through Danish national patient registry 4036 newly diagnosed cancer patients (male = 2176, female = 1860) Lim et al, 201438 Cervical England Research To collect data on nature and duration of symptoms and risk factors for delay in presentation and diagnosis in young females with cervical cancer. To inform approaches to promote early presentation and prompt referral among young females with symptoms of cervical cancer Semi-structured interview-based measure Eligible participants identified by 116 hospitals and publicising of study through charity websites 128 women (18–29 years) with recent diagnosis of cervical cancer Lyratzopoulos et al, 201529 Not specified N/A Perspective 1) To highlight factors involved in missed opportunities for cancer diagnosis among symptomatic patients; 2) Discuss potential mechanisms and approaches to accelerating progress towards minimising diagnostic delays post-presentation N/A All settings involved in diagnostic process including general practice and primary care N/A Mitchell et al, 201226 Lung, ovarian, upper GI England Toolkit Developed as a resource for use when considering ways to improve the diagnosis of cancer in primary care 1) National audit of cancer diagnosis in primary care;
2) Analysis of SEA;
3) Action plans for early cancer diagnosis derived using cancer-related practice profilesPrimary care 1) 1170 practices across 20 cancer networks;
2) SEA reports for 132 lung, 68 ovarian, and 78 upper GI cancer diagnoses;
3) general practices across EnglandMitchell et al, 20156 Brain, breast, carcinoid, CNS, colorectal, gynaecological, haematological, head and neck, lung, melanoma, sarcoma, upper GI, urological, unknown primary England Research 1) Understanding the cause of emergency presentations; 2) Determining the degree to which earlier intervention by general practice was possible Qualitative synthesis of SEAs 203 primary care practices across North of England Cancer Network 222 SEAs for most recent patients diagnosed with cancer as a result of an emergency presentation Molassiotis et al, 201039 Breast, GI, gynaecological, lung, brain, lymphoma, head and neck UK Research 1) To map the pathway from initial persistent change in health to diagnosis of cancer in a sample of patients from seven diagnostic groups in the UK; 2) Explore the patient and system factors mediating this process In-depth qualitative interviews Outpatient clinics at one large cancer hospital 74 patients (mean age 58.5 years; range 18–93 years) National Reporting and Learning Service, 201040 All cancers UK Thematic review 1) To explore issues of patient safety around delayed diagnosis of cancer; 2) Provide the NHS with potential solutions 1) Thematic review;
2) Review of incidents reported to the NPSA’s NRLS;
3) Consultation with stakeholders (focus groups, discussions, presentations);
4) Consideration of other patient safety data, such as complaints, litigation, and auditsPrimary and secondary care 1) N/A; 2) 508 patient safety incidents from random sample of 1500; 3) Two focus groups (n= 50); 4) NHS Litigation Authority; MDU Report (2003); MPS (analysis of 1000 cases of delayed or missed diagnosis); Scottish Primary Care Cancer Group reports of 4181 cancer cases Round et al, 201330 Not specified UK Essay To highlight clinician- and system-related factors that may be contributing to a delayed diagnosis of cancer in primary care N/A Primary care N/A Rubin et al, 201531 Not specified High-income countries/countries with universal healthcare systems Commission To distil the evidence for the effectiveness of interventions for cancer control based in primary care at each stage of the cancer journey, and to consider how cancer care might be delivered differently in the future. Discuss how and whether health policy for cancer control will help or hinder such change. Examines the implications for the future education and training of doctors, and identifies emerging examples of good practice worldwide N/A Primary and specialist care N/A Siminoff et al, 201141 Colorectal US Research 1) To describe the communication and symptom appraisal strategies of CRC patients;
2) Determine the patient and physician characteristics, consultation communication factors, follow-up recommendations, and the referral delay factors associated with DDSemi-structured interview and review of medical records for verification of patient-provided information Five academic and community oncology practices in two states 242 patients of any age (mean = 58.07 years) or sex (male = 126, female = 116) Stevens et al, 201242 Lung New Zealand Report To develop recommendations to improve the clinical pathway from presentation to diagnosis for people with suspected lung cancer Mixed methods utilising both quantitative and qualitative data:
1) Literature review;
2) National Stocktake;
3) Clinical audit;
4) Practice survey;
5) GP survey;
6) GP focus group;
7) Patient interviews;
8) Patient and family focus groupsFour primary care organisations and three DHBs within the Northern and Midland Cancer Networks 1) N/A; 2) Primary or secondary care services that could be relevant to people with lung cancer; 3) Clinical pathway from initial presentation to diagnosis (272 cases); 4) All general practices across two regions (n= 170); 5) 102 GPs across two regions; 6) 33 GPs across two regions; 7) 19 people suspected of having lung cancer who presented to a hospital ED; 8) 20 people (11 patients with lung cancer diagnosis [male = 5; female = 6] and nine family members) Walter et al, 201432 Cervical UK and international Editorial Not specified N/A Primary care N/A CNS = central nervous system. CRC = colorectal cancer. DD = diagnostic delay. DHB = district health board. ED = emergency department. GI = gastrointestinal. MDU = Medical Defence Union. MPS = Medical Protection Society. N/A = not applicable. NPSA = National Patient Safety Agency. NRLS = National Reporting and Learning System. QD = quality deviation. SEA = significant event audit.
1 Diagnosis/
2 diagn*.mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
3 Affect/
4 Clinical competence/
5 Communication/
6 “Continuity of Patient Care”/
7 Decision Making/
8 Decision Making, Organizational
9 Decision Support Systems, Clinical/
10 Decision Support Techniques/
11 Human Engineering/
12 Judgment/
13 Medical Informatics/
14 Medical Records Systems, Computerized/
15 Mental Recall/
16 Organizational Culture/
17 Patient Access to Records/
18 Feedback/
19 “Forms and Records Control”/st [Standards]
20 Guidelines as Topic/
21 Health Knowledge, Attitudes, Practice/
22 Health Literacy/
23 Health Records, Personal/
24 Physician’s Practice Patterns/
25 Problem Solving/
26 Professional-Patient Relations/
27 Reminder Systems/
28 Systems Analysis/
29 Time Factors/
30 Truth Disclosure/
31 Knowledge Bases/
32 (cognitive error or bias or metacognition).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
33 Patient Participation/
34 (patient adj2 involv*).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
35 involv*.mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
36 patient empowerment.mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
37 (((patient adj2 led) or patient) adj2 instigated).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
38 Primary Health Care/
39 Family Practice/
40 exp Community Health Services/
41 Partnership Practice/
42 Private Practice/
43 (medical adj2 office).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
44 Neoplasms/
45 ((cancer or neoplasm*) adj5 (diagnos* or detect*)).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
46 (neoplasm* or cancer* or carcinoma* or malignan* or lesion* or tumo?r*).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
47 (((family adj2 practice*) or (general adj2 practice*) or (primary adj2 care) or community) adj2 (service* or care)).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
48 ((((((delay* adj2 diagnos*) or diagnos*) adj2 delay*) or diagnos*) adj2 error*) or misdiagnos*).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
49 (missed adj2 diagnos*).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
50 (patient adj2 engagement).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, ui]
51 1 or 2 or 48 or 49
52 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 50
53 38 or 39 or 40 or 41 or 42 or 43
54 44 or 45 or 46
55 51 and 52 and 53 and 54
56 limit 55 to english language
57 remove duplicates from 56
1 Diagnosis/
2 ((((((((diagn* or delay*) adj2 diagnos*) or diagnos*) adj2 delay*) or diagnos*) adj2 error*) or misdiagnos* or missed) adj2 diagnos*).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]
3 Emotions/
4 clinical competence.mp.
5 Communication/
6 “continuity of patient care”.mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]
7 Decision Making/
8 decision making, organizational.mp.
9 decision support systems, clinical.mp.
10 Decision Support Systems/ or decision support techniques.mp.
11 human engineering.mp.
12 Judgment/
13 medical informatics.mp.
14 medical records, computerised.mp.
15 mental recall.mp.
16 Organizational Climate/
17 patient access to records.mp.
18 Feedback/
19 (forms and records control).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]
20 guidelines as topic.mp.
21 Health Attitudes/ or Health Knowledge/ or health knowledge, attitudes, practice.mp.
22 Health Literacy/
23 health records, personal.mp.
24 physician’s practice patterns.mp.
25 Problem Solving/
26 professional-patient relations.mp.
27 reminder systems.mp.
28 Systems Analysis/
29 time factors.mp.
30 truth disclosure.mp.
31 knowledge bases.mp.
32 (cognitive error or bias or metacognition).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]
33 (((((((patient adj2 involv*) or involv* or patient empowerment or patient) adj2 led) or patient) adj2 instigated) or patient) adj2 engagement).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]
34 patient participation.mp. or Client Participation/
35 Primary Health Care/
36 Family Medicine/
37 Health Care Services/
38 partnership practice.mp.
39 Private Practice/
40 (((((((((medical adj2 office) or family) adj2 practice*) or general) adj2 practice*) or primary) adj2 care) or community) adj2 (service* or care)).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]
41 Neoplasms/
42 (((cancer or neoplasm*) adj5 (diagnos* or detect*)) or neoplams* or cancer* or carcinoma* or malignan* or lesion* or tumo?r*).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]
43 1 or 2
44 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34
45 35 or 36 or 37 or 38 or 39 or 40
46 41 or 42
47 43 and 44 and 45 and 46
48 limit 47 to english language
Field Journal title Diagnosis and decision making Diagnosis Medical Decision Making Judgement and Decision Making Journal of Risk and Uncertainty Primary health care Family Practice British Journal of General Practice Annals of Family Medicine European Journal of General Practice Primary Health Care Research and Development Journal of Primary Care and Community Health Cancer British Journal of Cancer International Journal of Cancer European Journal of Cancer European Journal of Cancer Care Cancer BMC Cancer Journal of Cancer Patient Safety BMJ Quality & Safety Patient Education and Counselling Articles were retained if they met all of the following inclusion criteria:
1) The article was about diagnosis
2) The article discussed patient involvement in diagnosis
3) The article was in a primary care setting
4) The article was about cancer
Articles were excluded if:
1) The article reported or its focus was cancer screening programmes
2) The article was concerned only with paediatric patients
Articles were retained if they met all of the following inclusion criteria:
1) The article provided suggestions for potential interventions/strategies to involve patients in diagnosis at the post-presentation stage
2) The article identified components considered to be key for potential interventions/strategies to involve patients in diagnosis at the post-presentation stage
Articles were excluded if:
1) The article only evaluated symptom perception before presentation to primary care
2) The article only evaluated help-seeking behaviour before presentation to primary care
3) The focus of the article was on epidemiology (for example, patterns, causes, and effects for identifying risk factors and targets for prevention)
4) The purpose of the article was to identify which symptoms are most common, or algorithms for diagnosis
5) The article involved the monitoring or surveillance of high-risk and predisposed patients identified as being at increased risk of cancer
6) The article was about metastasis in patients who already had cancer
7) The article was a case study
8) The article was about the relatives of cancer patients
9) The article included no elaboration or detailed examples and suggestions for patient involvement
In this issue
Jump to section
- Top
- Article
- Abstract
- INTRODUCTION
- METHOD
- RESULTS
- DISCUSSION
- Acknowledgments
- Appendix 1. MEDLINE and Embase search terms
- Appendix 2. PsycINFO search terms
- Appendix 3. Journal search — field and journal title
- Appendix 4. Aim 1 inclusion and exclusion criteria
- Appendix 5. Aim 2 inclusion and exclusion criteria
- Notes
- REFERENCES
- Figures & Data
- Info
- eLetters
More in this TOC Section
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