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Doctors reluctant to discuss cancer referrals

30 December 2014

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More open discussion should take place between GPs and their patients when referring them for further investigation of symptoms indicating cancer claims a paper in the British Journal of General Practice (BJGP). 

As part of the National Institute for Health Research (NIHR) funded study, researchers from Cambridge, Durham and Exeter University conducted interviews with patients being referred for possible cancers.  

They found that patients were rarely consulted in the referral process and that non-specific terms were used to describe the referral even when the patient was on a cancer specific pathway. 

Dr Jon Banks, Research Programme Manager at the University of Bristol’s Centre for Academic Primary Care, said: “GPs face a difficult challenge when assessing whether to refer a patient for cancer investigation because many cancer symptoms are also caused by benign self-limiting illness. 

“A GP referring a patient with symptoms indicating risk levels around 5 per cent may withhold discussion about cancer because they do not want to raise patient anxiety, and it is known that patients can find being referred for cancer particularly stressful. 

“However our research has shown that the ‘tipping point’ for discussing cancer alongside referral for investigation could be set too high. We suggest that the tipping point for discussing the possibility of cancer should be moved to a lower level of risk.” 

The group also found a discrepancy between the aims of recent public health cancer awareness campaigns to encourage a cancer-based dialogue, and what is happening in clinical practice. 

Patients are being encouraged to go see their GP for what patients may perceive as everyday ailments, albeit they have persisted for longer than usual. The message is that it is appropriate to discuss these symptoms and the possibility of cancer with the GP. But our research indicates a reluctance among GPs to instigate these kinds of conversations.”