TY - JOUR
T1 - Missed opportunities for diagnosing brain tumours in primary care
T2 - a qualitative study of patient experiences
AU - Walter, Fiona M
AU - Penfold, Clarissa
AU - Joannides, Alexis
AU - Saji, Smiji
AU - Johnson, Margaret
AU - Watts, Colin
AU - Brodbelt, Andrew
AU - Jenkinson, Michael D
AU - Price, Stephen J
AU - Hamilton, Willie
AU - Scott, Suzanne E
N1 - © British Journal of General Practice 2019.
PY - 2019/4
Y1 - 2019/4
N2 - BACKGROUND: Brain tumours are uncommon, and have extremely poor outcomes. Patients and GPs may find it difficult to recognise early symptoms because they are often non-specific and more likely due to other conditions.AIM: To explore patients' experiences of symptom appraisal, help seeking, and routes to diagnosis.DESIGN AND SETTING: Qualitative study set in the East and North West of England.METHOD: In-depth interviews with adult patients recently diagnosed with a primary brain tumour and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework.RESULTS: Interviews were carried out with 39 patients. Few participants (n = 7; 18%) presented as an emergency without having had a previous GP consultation; most had had one (n = 15; 38%), two (n = 9; 23%), or more (n = 8; 21%) GP consultations. Participants experienced multiple subtle 'changes' rather than 'symptoms', often noticed by others rather than the patient, which frequently led to loss of interest or less ability to engage with daily living activities. The most common changes were in cognition (speaking, writing, comprehension, memory, concentration, and multitasking), sleep, and other 'head feelings' such as dizziness. Not all patients experienced a seizure, and few seizures were experienced 'out of the blue'. Quality of communication in GP consultations played a key role in patients' subsequent symptom appraisal and the timing of their decision to re-consult.CONCLUSION: Multiple subtle changes and frequent GP visits often precede brain tumour diagnosis, giving possible diagnostic opportunities for GPs. Refined community symptom awareness and GP guidance could enable more direct pathways to diagnosis, and potentially improve patient experiences and outcomes.
AB - BACKGROUND: Brain tumours are uncommon, and have extremely poor outcomes. Patients and GPs may find it difficult to recognise early symptoms because they are often non-specific and more likely due to other conditions.AIM: To explore patients' experiences of symptom appraisal, help seeking, and routes to diagnosis.DESIGN AND SETTING: Qualitative study set in the East and North West of England.METHOD: In-depth interviews with adult patients recently diagnosed with a primary brain tumour and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework.RESULTS: Interviews were carried out with 39 patients. Few participants (n = 7; 18%) presented as an emergency without having had a previous GP consultation; most had had one (n = 15; 38%), two (n = 9; 23%), or more (n = 8; 21%) GP consultations. Participants experienced multiple subtle 'changes' rather than 'symptoms', often noticed by others rather than the patient, which frequently led to loss of interest or less ability to engage with daily living activities. The most common changes were in cognition (speaking, writing, comprehension, memory, concentration, and multitasking), sleep, and other 'head feelings' such as dizziness. Not all patients experienced a seizure, and few seizures were experienced 'out of the blue'. Quality of communication in GP consultations played a key role in patients' subsequent symptom appraisal and the timing of their decision to re-consult.CONCLUSION: Multiple subtle changes and frequent GP visits often precede brain tumour diagnosis, giving possible diagnostic opportunities for GPs. Refined community symptom awareness and GP guidance could enable more direct pathways to diagnosis, and potentially improve patient experiences and outcomes.
KW - central nervous system neoplasms
KW - diagnosis
KW - primary brain neoplasms
KW - primary care
KW - symptoms
UR - http://www.scopus.com/inward/record.url?scp=85063906493&partnerID=8YFLogxK
U2 - 10.3399/bjgp19X701861
DO - 10.3399/bjgp19X701861
M3 - Article
C2 - 30858332
SN - 0960-1643
VL - 69
SP - E224-E234
JO - British Journal of General Practice
JF - British Journal of General Practice
IS - 681
M1 - e224-e235
ER -