Abstract

Introduction: Cancer risk assessment tools are novel tools that combine risk factors and symptoms to predict an individual’s risk of developing cancer. Little is known about the views of service users and primary care practitioners on how cancer risk assessment tools should be used in primary care. Following a scoping review of the literature, the qualitative study explored perspectives of service users and primary care practitioners about how best cancer risk information can be communicated to patients during primary care consultations. The study also explored the enablers (facilitators) and barriers to the implementation of cancer risk assessment tools from the perspectives of both service users and practitioners.

Methods: The scoping review followed the framework proposed by Arksey and O’Malley for conducting scoping reviews. The scoping review resulted in the statement of two research questions: (i) How best can cancer risk information be communicated to patients? (ii) What do service users and practitioners perceive as enablers and barriers to the implementation of cancer risk assessment tools in primary care?

The next phase was the qualitative study, which involved the use of individual and focus group interviews with service users recruited from the public and primary care practitioners (GPs and nurses) recruited from general practices in Lincolnshire, a large rural county in the East of England. The qualitative data were transcribed verbatim and analysed using the framework approach.

Results: Thirty-six participants (19 service users and 17 primary care practitioners) were interviewed before practitioners used cancer risk assessment tools in patient consultations. Some of the practitioner participants were interviewed again after they had used the tools in patient consultations.

Participants suggested ways to best communicate cancer risk information to patients in primary care consultations. Before using the tools with patients, participants emphasised the importance of: tailoring visual representation of risk; being open and honest; informing and involving patients in use of cancer risk assessment tools; and providing time for listening, explaining and reassuring in the context of a professional approach. After using the tools in patient consultations, primary care practitioners maintained these perceptions. These findings add to our knowledge and understanding of how best to communicate cancer risk information to patients when using cancer risk assessment tools in general practice consultations.

Before using the tools with patients, both service users and practitioners agreed on the following as potential enablers to the implementation of cancer risk assessment tools: aiding decision making; improving speed and processes of diagnosis and treatment of cancer; identifying and raising awareness for modifying health risk behaviours; and personalising care. After using the tools, primary care practitioners mentioned ‘ease of use’ in addition to the enablers already cited.

Barriers to the uptake of cancer risk assessment tools were also identified by participants, which included: the additional time required; worry and anxiety generated by referral for investigations; the potential for over-referral; practitioner scepticism about using the new tools; and the need for evidence of effectiveness before introducing cancer risk assessment tools in general practice consultations. These barriers were perceived before the use of the tools. After using the tools, practitioners identified the following barriers in addition to those already mentioned: the need to integrate the tools into general practice IT systems; the need to involve secondary care specialists (consultants) in the implementation of the tools; and the need for training of practitioners on how to use cancer risk assessment tools in patient consultations.

Conclusion: Ways to best communicate cancer risk information during patient consultations were identified in this study, adding to existing knowledge. Enablers and barriers to the implementation of cancer risk assessment tools were also identified by participants in this study.