Provider perceptions of interventions to encourage prevention and early diagnosis of cancer after a negative diagnosis

Problem

There are over 2 million referrals to the Two Week Wait Pathways in England annually and approximately 90% conclude with a negative (benign) diagnosis. There is evidence that patients can delay seeking help for the same or subsequent symptoms after investigations indicate a negative diagnosis for cancer, potentially due to over reassurance, fear of being perceived as hypochondrial or wasting doctor’s time, or just because patients are not sure what to do next. Negative diagnosis following referral for suspected cancer may be an under-utilised ‘teachable moment’ when people are more responsive and receptive to health information. The purpose of this study was to investigate healthcare professionals’ views about the feasibility of introducing new initiatives to offer advice and support to encourage early diagnosis and reduce future cancer risk, after an initial negative diagnosis.

Approach

Online, semi-structured interviews were conducted with practising NHS healthcare professionals involved in the referral or ongoing care of patients referred onto the two week wait pathway for suspected cancer. A convenience sample was used where participants were invited via NHS Trusts and professional networks e.g. Cancer Alliances. A topic guide was developed informed by the Capability-Opportunity-Motivation and Behaviour model. Interviews were audio-recorded, transcribed verbatim and analysed using Framework Analysis using both inductive coding, and deductive coding informed by the Theoretical Domains Framework.

Findings

36 healthcare professionals (n=14 from primary care, including practice nurses, GPs, dentist; N=22 from secondary care across referral pathways for 8 cancer sites) were interviewed between October and December 2021. Participants supported the need to explore additional ways to encourage early diagnosis of cancer. There was variability in the extent of support currently offered to patients after the two-week wait pathway for suspected cancer. Whether patients should or could be offered additional support and the content of that support was influenced by perceptions of resource requirements (e.g. consultation time, skill level of staff involved), along with judgements about the efficacy of the intervention for achieving health behaviour change, and the potential consequences including patient anxiety or confusion. Perceptions around the goals of the two week wait pathway and role of primary care influenced ideas about where support should be offered, healthcare professional’s motivation to offer support, and how support might be perceived by patients.

Consequences

Providers’ views usefully informed future intervention design. The content, format and delivery of initiatives directed towards patients who receive a negative diagnosis following urgent referral for suspected cancer needs to be resource-efficient, have proven impact and be coherent to patients in the context of their recent health experience.