Implementing a QCancer risk tool into general practice consultations: an exploratory study using simulated consultations with Australian general practitioners.
BACKGROUND
Reducing diagnostic delays in primary care by improving the assessment of symptoms associated with cancer could have significant impacts on cancer outcomes. Symptom risk assessment tools could improve the diagnostic assessment of patients with symptoms suggestive of cancer in primary care. We aimed to explore the use of a cancer risk tool, which implements the QCancer model, in consultations and its potential impact on clinical decision making.


METHODS
We implemented an exploratory 'action design' method with 15 general practitioners (GPs) from Victoria, Australia. General practitioners applied the risk tool in simulated consultations, conducted semi-structured interviews based on the normalisation process theory and explored issues relating to implementation of the tool.


RESULTS
The risk tool was perceived as being potentially useful for patients with complex histories. More experienced GPs were distrustful of the risk output, especially when it conflicted with their clinical judgement. Variable interpretation of symptoms meant that there was significant variation in risk assessment. When a risk output was high, GPs were confronted with numerical risk outputs creating challenges in consultation.


CONCLUSIONS
Significant barriers to implementing electronic cancer risk assessment tools in consultation could limit their uptake. These relate not only to the design and integration of the tool but also to variation in interpretation of clinical histories, and therefore variable risk outputs and strong beliefs in personal clinical intuition.
General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia.
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PP
Chiang
Centre for Software Practice, University of Western Australia, Crawley, Western Australia 6009, Australia.
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D
Glance
General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia.
J
J
Walker
1] The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK [2] General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia [3] General Practice, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia 6009, Australia.
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FM
Walter
1] General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia [2] General Practice, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia 6009, Australia [3] The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.
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JD
Emery
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D020000:Decision Support Systems, Clinical; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D016544:Patient Simulation; D011320:Primary Health Care; D012017:Referral and Consultation; D018570:Risk Assessment