title: Exploring GPs' experiences of using diagnostic tools for cancer: a qualitative study in primary care.
abstract: BACKGROUND
  The UK has an estimated 5-10000 extra cancer deaths each year when compared to other European countries and diagnostic delays are thought to make a significant contribution to this. One of the initiatives in England intended to support primary care professionals has been the development of cancer risk assessment tools (RATs). These tools assist in identifying and quantifying the risk of cancer in symptomatic primary care patients.
  
  
  OBJECTIVE
  To explore GPs' experiences of incorporating the RATs for lung and bowel cancers into their clinical practice and in so doing, identify constraints and facilitators to the wider dissemination of the tools in primary care.
  
  
  METHODS
  We conducted semi-structured interviews over the telephone with 11 project managers who implemented the study and 23 GPs who used the tool. The interviews were digitally recorded, professionally transcribed verbatim and analysed through the construction of a 'thematic framework'.
  
  
  RESULTS
  The training and support package was fundamental to the successful integration of the RATs into GPs' daily routines. Ongoing support from cancer networks alongside acknowledgement of the clinical expertize of the GPs by those implementing the study enhanced GPs' uptake of the tool in practice.
  
  
  CONCLUSIONS
  Findings suggest that the embedding of clinical decision support tools into clinical practice is more likely to be achieved when they are perceived to support but not supersede the clinical judgement of their users. This element of our findings is a focal point of this article.
authors.affiliation: Centre for Health and Population Sciences, Hull York Medical School, University of Hull, trish.green@hyms.ac.uk.
authors.forename: Trish
authors.initials: T
authors.lastname: Green
authors.affiliation: University of Exeter Medical School.
authors.forename: Tanimola
authors.initials: T
authors.lastname: Martins
authors.affiliation: University of Exeter Medical School.
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: School of Medicine, Pharmacy and Health, University of Durham, and.
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
authors.affiliation: kaeconsulting, London, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Elliott
authors.affiliation: Centre for Health and Population Sciences, Hull York Medical School, University of Hull.
authors.forename: Una
authors.initials: U
authors.lastname: Macleod
mesh_terms: D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods*; D004739:England; D058006:General Practice; D006801:Humans; D007407:Interviews as Topic; D007414:Intestinal Neoplasms / Q000175:diagnosis*; D008175:Lung Neoplasms / Q000175:diagnosis*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D036301:Qualitative Research; D018570:Risk Assessment
keywords: Clinical decision support tools; early detection of cancer; general practitioners; primary health care; qualitative research.