Barriers and facilitators to implementing a cancer risk assessment tool
(QCancer) in primary care: a qualitative interview study
Abstract
Rationale, aims and objectives: QCancer is a cancer risk assessment tool
that has been advocated for use in primary care to improve early
detection and diagnosis of cancer, but little is known about the views
of service users and practitioners on barriers and facilitators to
implementing the tool in practice. We aimed to explore the perspectives
of service users (adults without a current cancer) and primary care
practitioners (GPs and practice nurses) about barriers and facilitators
to using QCancer in primary care consultations. Methods: We used a
qualitative design, conducting individual interviews and focus groups
with a purposive sample of service users and practitioners. Interviews
were recorded and transcribed verbatim. Data were analysed using the
Framework approach facilitated by NVivo version 10. Results: We
interviewed 36 participants (19 service users, 17 practitioners).
Barriers to using the tool included: the need for additional
consultation time; unnecessary worry generated for some patients;
potential for over-referral; practitioner scepticism; potential conflict
with existing guidelines; certain symptoms requiring referral at any
risk; requirement for training on use of the tool; evidence of
effectiveness; and the need to integrate the tool in general practice
systems. Participants identified facilitators to use of the tool:
supporting decision making; modifying health behaviours; improving speed
of referral; and personalising care. Conclusion: The barriers and
facilitators identified should be considered when seeking to implement
QCancer in primary care. In particular, evidence is needed that the use
of this tool improves diagnosis rates without an unacceptable increase
in harm from unnecessary investigation.