Richard D Neal1, Iain J Robbé2, Malcolm Lewis3, Ian Williamson4, Jane Hanson5. 1. 1North Wales Centre for Primary Care Research,Bangor University,Wrexham,UK. 2. 2Clinical Assistant Professor,Division of Community Health and Humanities, Faculty of Medicine,Memorial University of Newfoundland,Canada. 3. 3Director Postgraduate Education for General Practice,School of Postgraduate Medical and Dental Education,Cardiff University,Cardiff,UK. 4. 4Consultant Chest Physician,Chair of the Lung sub-group,Cancer National Specialist Advisory Group,Southampton,UK. 5. 5Lead Adviser for Cancer,Welsh Government,Head of Cancer National Specialist Advisory Group Core Team,Cardiff,UK.
Abstract
AIM: This paper aims to provide a detailed analysis of the diagnostic process of lung cancer from a primary-care perspective. BACKGROUND: Diagnosing lung cancer at a stage where curative treatment is possible remains a challenge. Beginning to understand the complexity and difficulty in the diagnostic journey should enable the development of interventions in order to facilitate timelier diagnosis. METHODS: A national study of significant events was conducted whereby general practitioners (GPs) in Wales were asked to report data relating to the diagnostic process of recent lung cancer diagnoses using a standard template. Both qualitative and quantitative data were analysed. Findings Case reports were received from 96 general practices on 118 patients. A total of 96 patients (81.4%) presented with respiratory symptoms. A total of 79 patients (66.9%) had a GP-initiated X-ray before diagnosis. A total of 23 patients (19.5%) had a chest X-ray that did not initially show suspicion of lung cancer. A total of 25 patients (21.2%) were diagnosed after a GP-initiated acute admission. Analysis of free-text qualitative data showed that, for many patients, their GP behaved in an exemplary manner. However, for some patients, the GP could have made more of the opportunities presented for timelier diagnosis. There were a number of atypical and complex presentations, where the opportunities for more timely diagnosis were more limited. A variety of causes of diagnostic delays in secondary care were reported. These findings will inform health policy, and will inform the design of interventions to try to facilitate more timely diagnosis for symptomatic patients. We encourage greater compliance with diagnostic guidelines and greater vigilance for patients presenting with atypical symptoms, as well as for patients whose initial chest X-rays are normal.
AIM: This paper aims to provide a detailed analysis of the diagnostic process of lung cancer from a primary-care perspective. BACKGROUND: Diagnosing lung cancer at a stage where curative treatment is possible remains a challenge. Beginning to understand the complexity and difficulty in the diagnostic journey should enable the development of interventions in order to facilitate timelier diagnosis. METHODS: A national study of significant events was conducted whereby general practitioners (GPs) in Wales were asked to report data relating to the diagnostic process of recent lung cancer diagnoses using a standard template. Both qualitative and quantitative data were analysed. Findings Case reports were received from 96 general practices on 118 patients. A total of 96 patients (81.4%) presented with respiratory symptoms. A total of 79 patients (66.9%) had a GP-initiated X-ray before diagnosis. A total of 23 patients (19.5%) had a chest X-ray that did not initially show suspicion of lung cancer. A total of 25 patients (21.2%) were diagnosed after a GP-initiated acute admission. Analysis of free-text qualitative data showed that, for many patients, their GP behaved in an exemplary manner. However, for some patients, the GP could have made more of the opportunities presented for timelier diagnosis. There were a number of atypical and complex presentations, where the opportunities for more timely diagnosis were more limited. A variety of causes of diagnostic delays in secondary care were reported. These findings will inform health policy, and will inform the design of interventions to try to facilitate more timely diagnosis for symptomatic patients. We encourage greater compliance with diagnostic guidelines and greater vigilance for patients presenting with atypical symptoms, as well as for patients whose initial chest X-rays are normal.
Authors: Christopher G England; Dawei Jiang; Reinier Hernandez; Haiyan Sun; Hector F Valdovinos; Emily B Ehlerding; Jonathan W Engle; Yunan Yang; Peng Huang; Weibo Cai Journal: Mol Pharm Date: 2017-09-06 Impact factor: 4.939
Authors: Richard D Neal; Allan Barham; Emily Bongard; Rhiannon Tudor Edwards; Jim Fitzgibbon; Gareth Griffiths; Willie Hamilton; Kerenza Hood; Annmarie Nelson; David Parker; Cath Porter; Hayley Prout; Kirsty Roberts; Trevor Rogers; Emma Thomas-Jones; Angela Tod; Seow Tien Yeo; Chris N Hurt Journal: Br J Cancer Date: 2017-01-10 Impact factor: 7.640
Authors: Usha Menon; Peter Vedsted; David Weller; Alina Zalounina Falborg; Henry Jensen; Samantha Harrison; Irene Reguilon; Andriana Barisic; Rebecca J Bergin; David H Brewster; John Butler; Odd Terje Brustugun; Oliver Bucher; Victoria Cairnduff; Anna Gavin; Eva Grunfeld; Elizabeth Harland; Jatinderpal Kalsi; Anne Kari Knudsen; Mats Lambe; Rebecca-Jane Law; Yulan Lin; Martin Malmberg; Donna Turner; Richard D Neal; Victoria White Journal: BMJ Open Date: 2019-11-27 Impact factor: 2.692