Making contacts count? Views of patients and practitioners on cancer risk discussions in primary care: a qualitative interview study
In the UK, nearly 600,000 cancer cases could have been avoided in the last five years if people had healthier lifestyles, with the principle modifiable risk factors being smoking, obesity, alcohol and inactivity. In theory, GPs are well placed to discuss and support health behaviour change related to these risk factors, in keeping with the WHO’s renewed declaration for primary health care.To support such discussions, researchers in Cambridge developed a personalised cancer risk calculator and found there was enthusiasm for its use in general practice. It is unclear, however, if practitioners in the less affluent context of Glasgow, where health literacy and life expectancy are lower (and the prevalence of multiple unhealthy behaviours is higher) hold the same views. The aim of this study is to explore the views and experiences of patients and practitioners (GPs and practice nurses) in relation to cancer prevention and cancer risk discussions in general practice, particularly in more deprived areas.
Qualitative study involving semi-structured interviews. In the first stage, a purposive sample of 10 primary care practitioners (5 GPs and 5 practice nurses) were recruited from a range of practices, based on practice list size (small, medium, large) and deprivation status (low, medium, high). In the second stage, 16 patients aged 30 to 60 from participating practices were recruited, if they had 2 or more of: current smoker, obesity, diabetes, hypertension, coronary heart disease. People with a history of cancer or deemed unsuitable to take part by their GP were excluded. The theoretical frameworks of candidacy and normalisation process theory informed data analysis.
This is work in progress, but findings from practitioner interviews suggest mixed views about the potential utility of personalised cancer risk tools in routine primary care consultations, with concerns about time constraints and opportunity costs, especially in more deprived areas, and about uncertain evidence of benefit.
Health behaviour change is complex and the provision of information alone is unlikely to have significant effects.The views of those affected – patients and practitioners – must be taken into account before the introduction of any new technologies in general practice.