Abstract

Introduction: Earlier detection of cancer may help reduce the current high level of cancer mortality in the UK. Cancer risk assessment tools such as QCancer, which predict the absolute risk of cancer in symptomatic individuals, may help identify those at high risk needing investigation for possible cancer. Little is known about the views of service users and primary care practitioners on the use of QCancer in primary care consultations. The aim of this study was to explore the perspectives of service users and primary care practitioners on use of QCancer and how communication with patients might be enhanced when using QCancer in primary care consultations.

Methods: The study was conducted in Lincolnshire, a large rural county in the East Midlands, using a qualitative research design. This involved individual interviews with service users recruited from the general public, and both individual and focus group interviews with primary care practitioners including general practitioners and practice nurses. Data were recorded, transcribed verbatim and analysed using the framework approach. Ethics approval was granted by the University of Lincoln School of Health and Social Care Ethics Committee.

Results: We interviewed 36 participants (19 service users and 17 practitioners) until data saturation was achieved. Four main themes emerged: the implications of quantifying cancer risk; usefulness of QCancer; communicating cancer risk and barriers to implementation in primary care consultations.

Participants expressed a range of views about the implications of quantifying cancer risk using QCancer. These included: potential conflict with current cancer risk guidelines and the need to refer patients with symptoms suggestive of cancer whatever their quantified risk.

Participants agreed that QCancer would help to: quantify cancer risk; support clinical decision making; inform efforts to modify health behaviours; improve processes and speed of assessments, diagnosis and treatment; and, enable practitioners to personalise patient care.

To enhance patient-practitioner communication of cancer risk, both service users and primary care practitioners suggested the following: tailoring a visual representation of risk; being honest and open with patients; involving patients in the use of QCancer; and allowing time for listening, explaining, informing and reassuring patients.

Potential challenges to the uptake of QCancer were also identified including: the additional time required for its use and communication; unnecessary worry caused by investigation of false positives; potential for over-referral; and practitioner scepticism with the need to establish the effectiveness of QCancer against current practice before introducing it more widely.

Conclusion: Participants perceived the potential usefulness of QCancer but felt that communication needs of users and potential barriers should be considered when planning to implement QCancer. Before rolling out the tool, further research is needed to pilot and evaluate the impact of QCancer on outcomes such as rates of investigations, referrals, diagnoses as well as patient and practitioner experiences of using the tool.