RT Journal Article
SR Electronic
T1 Missed opportunities for diagnosing brain tumours in primary care: a qualitative study of patient experiences
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e224
OP e235
DO 10.3399/bjgp19X701861
VO 69
IS 681
A1 Fiona M Walter
A1 Clarissa Penfold
A1 Alexis Joannides
A1 Smiji Saji
A1 Margaret Johnson
A1 Colin Watts
A1 Andrew Brodbelt
A1 Michael D Jenkinson
A1 Stephen J Price
A1 Willie Hamilton
A1 Suzanne E Scott
YR 2019
UL http://bjgp.org/content/69/681/e224.abstract
AB Background Brain tumours are uncommon, and have extremely poor outcomes. Patients and GPs may find it difficult to recognise early symptoms because they are often non-specific and more likely due to other conditions.Aim To explore patients’ experiences of symptom appraisal, help seeking, and routes to diagnosis.Design and setting Qualitative study set in the East and North West of England.Method In-depth interviews with adult patients recently diagnosed with a primary brain tumour and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework.Results Interviews were carried out with 39 patients. Few participants (n = 7; 18%) presented as an emergency without having had a previous GP consultation; most had had one (n = 15; 38%), two (n = 9; 23%), or more (n = 8; 21%) GP consultations. Participants experienced multiple subtle ‘changes’ rather than ‘symptoms’, often noticed by others rather than the patient, which frequently led to loss of interest or less ability to engage with daily living activities. The most common changes were in cognition (speaking, writing, comprehension, memory, concentration, and multitasking), sleep, and other ‘head feelings’ such as dizziness. Not all patients experienced a seizure, and few seizures were experienced ‘out of the blue’. Quality of communication in GP consultations played a key role in patients’ subsequent symptom appraisal and the timing of their decision to re-consult.Conclusion Multiple subtle changes and frequent GP visits often precede brain tumour diagnosis, giving possible diagnostic opportunities for GPs. Refined community symptom awareness and GP guidance could enable more direct pathways to diagnosis, and potentially improve patient experiences and outcomes.