LB30
Significant Event Audits (SEA) of cancer diagnoses in primary care: framework analysis
Elizabeth Mitchell1, Una Macleod2, Greg Rubin3
1University of Dundee, UK, 2University of Glasgow, UK, 3Durham University, UK
Background
The principal method of identification of cancer in the UK is symptomatic presentation, typically to general practitioners, who are the usual
source of referral to specialists. Significant Event Audit is a quality
improvement technique routinely used in general practice. This study
aimed to gain insights into the diagnostic process for lung cancer and cancers
affecting teenagers and young adults, drawn from secondary analysis of SEA
reports.
Method
202 practices in two NHS areas in north east England were invited to
participate and asked to identify the last registered patient diagnosed with
lung cancer, and the last diagnosed with cancer as a teenager or young adult,
even if that patient was now deceased. Documented accounts were
synthesised and a qualitative approach to analysis adopted, involving
development of an interpretative matrix based on a modified framework approach,
and analysis of the reflections of practitioners.
Results
SEA reports were returned by 92 practices (46%) for 132 lung and 35 TYA
cancers. Interpretation of these accounts demonstrated the complexity of
the process of diagnosis in general practice. Most SEAs demonstrated
appropriate recognition and referral; where that process took longer, there
were often reasonable explanations. For lung cancer these included chest
x-rays reported as normal or with findings consistent with benign disease, and
patient factors such as time to re-presentation. For TYA cancers, these
were related to very unusual presentations in extremely rare cancers.
Some examples of opportunities for earlier diagnosis were also found.
Learning points identified by practices included presentation and diagnosis,
safety-netting, system issues and the primary/secondary care interface, patient
related factors, practitioner issues, and the role of guidelines.
Conclusion
This is a novel approach to investigating circumstances surrounding
diagnosis and referral for cancer symptoms in primary care. Valuable
insights into this process have been identified, resulting in useful
recommendations for practice.
