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Research

Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

Laura Jefferson, Karl Atkin, Rebecca Sheridan, Steven Oliver, Una Macleod, Geoff Hall, Sarah Forbes, Trish Green, Victoria Allgar and Peter Knapp
British Journal of General Practice 2019; 69 (689): e850-e859. DOI: https://doi.org/10.3399/bjgp19X706625
Laura Jefferson
University of York, York.
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Karl Atkin
University of York, York.
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Rebecca Sheridan
University of York, York.
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Steven Oliver
University of York, Hull York Medical School, Hull and York.
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Una Macleod
University of Hull, Hull York Medical School, Hull and York.
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Geoff Hall
University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds.
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Sarah Forbes
Oakwood Lane Medical Practice, Leeds.
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Trish Green
University of Hull, Hull York Medical School, Hull and York.
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Victoria Allgar
University of York, Hull York Medical School, Hull and York.
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Peter Knapp
University of York, Hull York Medical School, Hull and York.
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Abstract

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.

  • cancer
  • communication
  • diagnosis
  • no-show patients
  • primary health care
  • socioeconomic factors
  • Received April 15, 2019.
  • Revision requested June 18, 2019.
  • Accepted August 20, 2019.
  • © British Journal of General Practice 2019

This article is Open Access: CC BY-NC 4.0 licence (http://creativecommons.org/licences/by-nc/4.0/).

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British Journal of General Practice: 69 (689)
British Journal of General Practice
Vol. 69, Issue 689
December 2019
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Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs
Laura Jefferson, Karl Atkin, Rebecca Sheridan, Steven Oliver, Una Macleod, Geoff Hall, Sarah Forbes, Trish Green, Victoria Allgar, Peter Knapp
British Journal of General Practice 2019; 69 (689): e850-e859. DOI: 10.3399/bjgp19X706625

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Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs
Laura Jefferson, Karl Atkin, Rebecca Sheridan, Steven Oliver, Una Macleod, Geoff Hall, Sarah Forbes, Trish Green, Victoria Allgar, Peter Knapp
British Journal of General Practice 2019; 69 (689): e850-e859. DOI: 10.3399/bjgp19X706625
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Keywords

  • cancer
  • communication
  • diagnosis
  • no-show patients
  • primary health care
  • socioeconomic factors

More in this TOC Section

  • Evaluation of a primary care-based opioid and pain review service: a mixed-methods evaluation in two GP practices in England
  • Factors affecting use of unscheduled care for people with advanced cancer: a retrospective cohort study in Scotland
  • Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review
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© 2019 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242