3.1.5 Conflict with existing guidelines
Service users felt that guidance needed to be consistent, while practitioners felt it might be confusing to use a cancer risk assessment tool with existing guidelines e.g. National Institute for Health and Care Excellent (NICE) guidelines. This relates to the constructs of compatibility and complexity within the CFIR.10 In line with this, participants stated:
“I think it is good for everybody to have the same sort of guidelines, so to use risk assessment tools, everybody should use the same sort of guidelines” (Service User 1: individual interview).
“I will be quite confused about using the tool. I mean you know with the NICE guidelines, you couldn’t focus on another criterion for any other risk here, and I mean there are implications for the wider… investigations, referrals…., it has to be very much a more repeated secondary approach” (Practitioner 11 [GP]: FG 1).
3.1.6 High risk symptoms need referral at any risk
Participants also felt that symptoms suggesting the presence of cancer needed to be referred for further investigation, regardless of any quantified risk using the tool:
“It doesn’t really matter about percentages; I know 1% is less risk. But the fact is the symptom is there, the coughing out of blood, which is quite worrying” (Service User 13: individual interview).
“Regardless of what the tool said I will refer them for investigation with the symptoms. So, it doesn’t matter 1% or 0%, I will always do one thing, investigation if the symptoms are suggestive of cancer ” (Practitioner 11 [GP]: FG 1).
3.1.7 Need for training on how to use the tools
Another barrier identified by practitioners was their lack of understanding on how to use the tool during a consultation, including using these correctly to calculate risk, understanding what the predicted risk meant and communicating the results to patients. They felt that training on how to use the tool in patient consultations was needed:
“We don’t quite understand how to use that tool. I think we need to have proper education or training on using these tools. The other day I met a lady from the Macmillan Cancer Support, and I asked her to see if they could come and give us a training session or talk on how to use the cancer risk assessment tools in patient consultations. I think we need to follow that up because the tools look good to use”(Practitioner 2 [GP]: FG 3).