Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

L Jefferson; K Atkin; R Sheridan; S Oliver; U Macleod; G Hall; S Forbes; T Green; V Allgar; P Knapp

doi:10.3399/bjgp1919x706625

Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

L Jefferson, K Atkin, R Sheridan, S Oliver, U Macleod, G Hall, S Forbes, T Green, V Allgar, P Knapp

Peninsula Medical School

Research output: Contribution to journal › Article › peer-review

Abstract

BackgroundThe 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.AimTo examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance.Design and settingQualitative study in GP practices in one Northern English city.MethodIn-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.ResultsIn this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.ConclusionFailure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.

Original language	English
Pages (from-to)	bjgp1919X706625-bjgp1919X706625
Number of pages	0
Journal	British Journal of General Practice
Volume	0
Issue number	0
DOIs	https://doi.org/10.3399/bjgp1919x706625
Publication status	E-pub ahead of print - 18 Nov 2019

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Jefferson, L., Atkin, K., Sheridan, R., Oliver, S., Macleod, U., Hall, G., Forbes, S., Green, T., Allgar, V., & Knapp, P. (2019). Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs. British Journal of General Practice, 0(0), bjgp1919X706625-bjgp1919X706625. Advance online publication. https://doi.org/10.3399/bjgp1919x706625

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title = "Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs",

abstract = "BackgroundThe 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.AimTo examine how interpersonal, communication, social, and organisational factors influence a patient{\textquoteright}s non-attendance.Design and settingQualitative study in GP practices in one Northern English city.MethodIn-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.ResultsIn this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading {\textquoteleft}difficult lives{\textquoteright}; and patients{\textquoteright} expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.ConclusionFailure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.",

author = "L Jefferson and K Atkin and R Sheridan and S Oliver and U Macleod and G Hall and S Forbes and T Green and V Allgar and P Knapp",

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doi = "10.3399/bjgp1919x706625",

language = "English",

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Jefferson, L, Atkin, K, Sheridan, R, Oliver, S, Macleod, U, Hall, G, Forbes, S, Green, T, Allgar, V & Knapp, P 2019, 'Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs', British Journal of General Practice, vol. 0, no. 0, pp. bjgp1919X706625-bjgp1919X706625. https://doi.org/10.3399/bjgp1919x706625

TY - JOUR

T1 - Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

AU - Jefferson, L

AU - Atkin, K

AU - Sheridan, R

AU - Oliver, S

AU - Macleod, U

AU - Hall, G

AU - Forbes, S

AU - Green, T

AU - Allgar, V

AU - Knapp, P

PY - 2019/11/18

Y1 - 2019/11/18

N2 - BackgroundThe 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.AimTo examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance.Design and settingQualitative study in GP practices in one Northern English city.MethodIn-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.ResultsIn this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.ConclusionFailure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.

AB - BackgroundThe 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.AimTo examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance.Design and settingQualitative study in GP practices in one Northern English city.MethodIn-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.ResultsIn this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.ConclusionFailure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.

U2 - 10.3399/bjgp1919x706625

DO - 10.3399/bjgp1919x706625

M3 - Article

SN - 0960-1643

VL - 0

SP - bjgp1919X706625-bjgp1919X706625

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 0

ER -

Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

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