Decision making and referral from primary care for possible lung and colorectal cancer: a qualitative study of patients' experiences

Br J Gen Pract. 2014 Dec;64(629):e775-82. doi: 10.3399/bjgp14X682849.


Background: The challenge for GPs when assessing whether to refer a patient for cancer investigation is that many cancer symptoms are also caused by benign self-limiting illness. UK National Institute for Health and Care Excellence (NICE) referral guidelines emphasise that the patient should be involved in the decision-making process and be informed of the reasons for referral. Research to date, however, has not examined the extent to which these guidelines are borne out in practice.

Aim: To assess the degree to which patients are involved in the decision to be referred for investigation for symptoms associated with cancer and their understanding of the referral.

Design and setting: Qualitative interview study of patients referred to secondary care for symptoms suspicious of lung and colorectal cancer. Patients were recruited from two regions of England using maximum variation sampling.

Method: Transcribed interviews were analysed thematically.

Results: The analysis was based on 34 patient interviews. Patients in both symptom pathways reported little involvement in the decision to be referred for investigation. This tended to be accompanied by a patient expectation for referral, however, to explain ongoing and un-resolving symptoms. It was also found that reasons for referral tended to be couched in non-specific terms rather than cancer investigation, even when the patient was on a cancer-specific pathway.

Conclusion: GPs should consider a more overt discussion with patients when referring them for further investigation of symptoms suspicious of cancer. This would align clinical practice with NICE guidelines and encourage more open discussion between GPs and primary care patients around cancer.

Keywords: colorectal cancer; decision making; lung cancer; primary health care; qualitative research; referral and consultation.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety / epidemiology*
  • Anxiety / etiology
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / psychology
  • Decision Making*
  • Early Detection of Cancer* / psychology
  • England / epidemiology
  • Health Services Accessibility / organization & administration*
  • Humans
  • Interviews as Topic
  • Lung Neoplasms / diagnosis*
  • Lung Neoplasms / psychology
  • Patient Participation*
  • Physician-Patient Relations
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Primary Health Care / organization & administration*
  • Qualitative Research
  • Referral and Consultation / organization & administration*