title: Managing risk in cancer presentation, detection and referral: a qualitative study of primary care staff views.
abstract: OBJECTIVE
  In the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer.
  
  
  METHODS
  Six primary care practices in northwest England.
  
  
  METHODS
  39 primary care staff from a variety of disciplines took part in five group and four individual interviews.
  
  
  RESULTS
  The global theme to emerge from the interviews was 'managing risk', which had three underpinning organising themes: 'complexity', relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; 'continuity', relating to relationships between practice staff and their patients and between primary and secondary care; 'conflict' relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care.
  
  
  CONCLUSIONS
  Primary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives.
authors.affiliation: School of Medicine and Dentistry, University of Central Lancashire, Preston, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Cook
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Thomson
authors.affiliation: School of Medicine and Dentistry, University of Central Lancashire, Preston, UK.
authors.forename: Paola
authors.initials: P
authors.lastname: Dey
mesh_terms: D001291:Attitude of Health Personnel; D042241:Early Diagnosis; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis*; D011320:Primary Health Care; D036301:Qualitative Research; D012017:Referral and Consultation; D012308:Risk Management / Q000458:organization & administration*
keywords: PUBLIC HEALTH; QUALITATIVE RESEARCH