The '2-week rule' for suspected breast carcinoma: a qualitative study of the views of patients and professionals.
BACKGROUND
The '2-week rule' for the referral of patients with potential cancers is an important but controversial development.


OBJECTIVE
To investigate the 2-week rule for women with breast problems from the perspective of the patients and of healthcare professionals.


METHODS
Qualitative study using semi-structured interviews.


METHODS
Patients referred to two breast care units and professionals from primary and secondary care in Teesside and Hartlepool.


METHODS
Semi-structured interviews with a purposive sample of 12 patients referred under the 2-week rule and 20 professionals.


RESULTS
All women experienced considerable worries in the time leading up to diagnosis. This affected relationships with others, and they used selective telling to help maintain control over their own anxiety and prevent anxiety in others. They were not aware of the 2-week rule as a new initiative, but wanted quick referral to assure them that they did not have cancer. Patients felt they needed more information about breast symptoms and the referral process. Comments about communication with professionals, both good and poor, were frequent in their accounts, which contrasted with the absence of such concerns in the accounts of the professionals. The professionals thought that the 2-week rule was advantageous in reducing anxiety, but thought that disadvantages included longer waits for patients referred outside the rule and increased pressure on hospital services. Cultural changes, including increased patient assertiveness and 'breast awareness', were considered important contextual factors. General practitioners (GPs) were concerned about missing diagnoses in patients statistically unlikely to have carcinomas.


CONCLUSIONS
Differences in emphasis were apparent, with patients wanting to be assured that they did not have cancer, specialists concerned both about increased workload and the impact on patients with cancers, and GPs anxious about missing diagnoses. The 2-week rule compromises professional autonomy, which partially accounts for the anger directed against it. There is a need for patients to have more information, and they place great value on good communication. All patient responders experienced significant distress while waiting to be seen.
Centre for Integrated Health Care Research, University of Durham, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees TS17 6BH. charles.cornford@durham.ac.uk
Charles S
CS
Cornford
Jan
J
Harley
Nigel
N
Oswald
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology; D004739:England; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D012017:Referral and Consultation / Q000592:standards*; D013997:Time Factors