The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports.
BACKGROUND
Patients diagnosed with cancer in the context of an emergency presentation (EP) have poorer outcomes. It is often assumed that such patients present to the emergency department without consulting their general practitioner (GP). Little work has been done to identify primary care involvement before hospital attendance.


METHODS
Participating primary care practices completed a significant event audit (SEA) report for the last patient diagnosed with cancer as a result of an EP. Accounts were synthesised and a qualitative approach to analysis undertaken.


RESULTS
SEAs for 222 patients were analysed. A range of cancers were included, the most common being lung (32.4%) and upper gastrointestinal (19.8%). In most cases, patients had contact with their practice before diagnosis, primarily in the period immediately before admission. In only eight cases had there been no input from primary care. Accounts of protracted primary care contact generally demonstrated complexity, often related to comorbidity, patient-mediated factors or reassurance provided by negative investigations. Learning points identified by practices centred on the themes of presentation and diagnosis, consultation and safety-netting, communication and system issues, patient factors and referral guidelines.


CONCLUSIONS
There is extensive primary care input into patients whose diagnosis results from EP, and for the most part potential 'delay' in referral can be reasonably explained by the complexity of the presentation or by coexisting patient factors.
Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK.
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Mitchell
Durham University, School of Medicine, Pharmacy and Health, Wolfson Building, Queen's Campus, University Boulevard, Stockton-on-Tees TS17 6BH, UK.
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G
Rubin
North Derbyshire Clinical Commissioning Group, The Springs Health Centre, Recreation Close, Clowne, Chesterfield S43 4PL, UK.
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Merriman
Hull York Medical School, University of Hull, Hertford Building, Cottingham Road, Hull HU6 7RX, UK.
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Macleod
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis; D058006:General Practice; D005833:Genital Neoplasms, Female / Q000175:diagnosis; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D011320:Primary Health Care; D036301:Qualitative Research; D012017:Referral and Consultation; D055815:Young Adult