What is the perceived knowledge, attitudes and behaviour of General Practitioners regarding referral and investigation for suspected cancer symptoms?

Problem

Cancer outcomes in the UK are worse than many similar countries. One contributory factor for this is the length of the ‘primary care interval’ (the time from first presentation of a ‘cancer symptom’ to onward referral or diagnostic investigation). Part of the solution therefore is to develop and evaluate behaviour change interventions to expedite the diagnosis of symptomatic cancer. The Wales Interventions and Cancer Knowledge about Early Diagnosis (‘WICKED’) programme is designed to develop and evaluate such interventions. It comprises several inter-connected work packages including the survey that is reported here. The aim of this survey is to determine GPs’ perceived cancer knowledge, attitudes and behaviour regarding referral and investigation for suspected cancer symptoms.

Approach

An online questionnaire was developed through a review of reviews, expert consensus, and integration of the Capability, Opportunity, and Motivation-Behaviour (COM-B) model of the Behaviour Change Wheel (BCW). The final questionnaire comprised: demographic information; questions about perceptions and attitudes towards early cancer diagnosis within their day-to-day practice; and the COM-B Self-evaluation Questionnaire anchored to referral and investigative behaviour. All GPs in Wales were invited to achieve a minimum of 200 responders.

Findings

269/1993 (13.5%) GPs responded, and were broadly representative of GPs in Wales in terms of personal and practice factors. There was strong agreement amongst respondents that they had changed their behaviour with regard to safety-netting of symptoms, and changing thresholds for investigation and referral, but less so for the use of decision support tools. The most prominent drivers of these changes were: case discussions with colleagues and significant event audits. There was strong agreement that timelier diagnosis leads to better survival for the six cancers asked (breast, colorectal, endometrial, myeloma, pancreas and renal), and that GPs had a large amount of influence on timely diagnosis of these cancers. Respondents were less confident about patient management when they did not have qualifying symptoms for urgent referral. GPs expressed varying preferences for Capability, Opportunity and Motivation factors that would help them to refer better. The results will be presented in full at the meeting.

Consequences

GPs can, and have, changed their cancer related diagnostic activity, and believe that they can influence timely diagnosis. They also identified a number of ways in which future interventions may be targeted to maximise behaviour change. This will inform our intervention development.