Department of Nursing, Umeå University, Umeå, Sweden
Cecilia Högberg
Department of Public Health and Clinical Medicine, Education and Development Östersund, Unit of Research, Umeå University, Umeå, Sweden
Mercè Marzo-Castillejo
Research Support Unit Metropolitana Sud, University Institute for Primary Health Care Research IDIAPJordi Gol, Catalan Health Institute, Barcelona, Spain
Vija Siliņa
Department of Family Medicine, Riga Stradiņš University, Riga, Latvia
Jolanta Sawicka-Powierza
Department of Family Medicine, Medical University of Białystok, Białystok, Poland
Magadalena Esteva
Majorca Primary Care Department, Spain
Tuomas Koskela
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
Davorina Petek
Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Sara Contreras-Martos
Research Support Unit Metropolitana Sud, University Institute for Primary Health Care Research IDIAPJordi Gol, Catalan Health Institute, Barcelona, Spain
Marcello Mangione
Local Health Authority Committee, Palermo City, Italy
Zlata Ožvačić Adžić
Department of Family Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
Radost Asenova
Department Urology and General Practice, Medical University of Plovdiv, Plovdiv, Bulgaria
Svjetlana Gašparović Babić
Croatian Health Insurance Fund, Rijeka, Croatia
Mette Brekke
Department of Health and Society, General Practice Research Unit, University of Oslo, Oslo, Norway
Krzysztof Buczkowski
Nicolaus Copernicus University, Toruń, Poland
Nicola Buono
Department of General Practice, National Society of Medical Education in General Practice (SNaMID), Caserta, Italy
Saliha Serap Çifçili
Family Medicine Department, Marmara University Medical School, Istanbul, Turkey
Geert-Jan Dinant
Department of General Practice, Maastricht University, Maastricht, The Netherlands
Babette Doorn
Department of General Practice, Maastricht University, Maastricht, The Netherlands
Robert D Hoffman
Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
George Kuodza
Department of Family Medicine and Outpatient Care, Medical Faculty #2, Uzhhorod National University, Uzhgorod, Ukraine
Peter Murchie
Centre of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
Liina Pilv
Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
Aida Puia
Department of Family Medicine, University of Medicine and Pharmacy, Cluj-Napoca, Romania
Aurimas Rapalavicius
Family Medicine Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
Emmanouil Smyrnakis
Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
Birgitta Weltermann
Institut für Hausarztmedizin, University of Bonn, Bonn, Germany
Background: While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. Aim: To explore European PCPs’ experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. Design & setting: A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. Method: Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. Results: A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients’ descriptions did not suggest cancer; distracting factors reduced PCPs’ cancer suspicions; patients’ hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. Conclusion: The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The ‘Swiss cheese’ model of accident causation showed how the themes related to each other.
