Factors affecting patient decisions to undergo testing for cancer symptoms: an exploratory qualitative study in Australian general practice

BACKGROUND: Patients presenting to their GP are often concerned their symptoms may be due to cancer. However, there is a lack of evidence on the factors that influence patient decisions to undergo investigation for suspected cancer in the general practice setting. AIM: To identify the factors influencing patient decisions to undertake investigations for suspected cancer in general practice. DESIGN & SETTING: An exploratory qualitative, semi-structured interview study of patients attending rural and metropolitan general practices in Victoria, Australia. METHOD: A purposive sample of 15 general practice patients aged ≥40 years participated. Thematic analysis of transcripts drew on interpretative description methodology and shared decision-making (SDM) theory. RESULTS: Cancer-related concerns such as ‘cancer worry’ prompt patients to seek investigations from their GP. Participants prefer that their symptoms are investigated regardless of cancer risk. The perceived ‘best test’ provides the most reassurance. Trust and SDM enhance dialogue between patients and GPs about diagnostic testing strategies. Deterrents to testing included out-of-pocket costs, waiting time, travel time, and competing work and family demands. CONCLUSION: There may be a mismatch between efforts to rationalise investigation use and patient preferences for investigation. SDM that incorporates patient concerns, facilitators, and barriers to testing may ensure appropriate and timely investigation of cancer symptoms.