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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 involvem...

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Autores principales: Mitchell, E D, Rubin, G, Merriman, L, Macleod, U
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385976/
https://www.ncbi.nlm.nih.gov/pubmed/25734395
http://dx.doi.org/10.1038/bjc.2015.42
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author Mitchell, E D
Rubin, G
Merriman, L
Macleod, U
author_facet Mitchell, E D
Rubin, G
Merriman, L
Macleod, U
author_sort Mitchell, E D
collection PubMed
description 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.
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spelling pubmed-43859762015-04-07 The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports Mitchell, E D Rubin, G Merriman, L Macleod, U Br J Cancer Full Paper 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. Nature Publishing Group 2015-03-31 2015-03-03 /pmc/articles/PMC4385976/ /pubmed/25734395 http://dx.doi.org/10.1038/bjc.2015.42 Text en Copyright © 2015 Cancer Research UK http://creativecommons.org/licenses/by/4.0/ This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
spellingShingle Full Paper
Mitchell, E D
Rubin, G
Merriman, L
Macleod, U
The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports
title The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports
title_full The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports
title_fullStr The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports
title_full_unstemmed The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports
title_short The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports
title_sort role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports
topic Full Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385976/
https://www.ncbi.nlm.nih.gov/pubmed/25734395
http://dx.doi.org/10.1038/bjc.2015.42
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