E-poster Presentation 2014 World Cancer Congress

Implementing QCancer into General Practitioner (GP) consultations: exploratory study using simulated consultations with Australian GPs. (#663)

Peggy PC Chiang , David Glance , Jennifer Walker , Jon Emery

Background: The QCancer risk tool has the potential to improve the diagnostic assessment of patients with symptoms suggestive of cancer in primary care. Aim: To investigate the feasibility of QCancer for translation into routine practice.Methods: Purposive sample of 15 GPs from Victoria, Australia. Qualitative analysis of semi-structured interviews and video recordings of simulated consultations to prompt use of a modified QCancer risk tool incorporating diagnostic referral guidance.Results: Experienced GPs found the QCancer risk tool to have limited value in their clinical practice. Less experienced GPs were more positive about its potential to inform diagnostic decision making. This partly reflects the low prevalence and rare experience of certain cancers in primary care. Large variations were found in interpreting the clinical history and symptom boxes in QCancer. Markedly different risk estimates were produced for the same simulated case. When multiple possible cancers were highlighted, ease of access and invasiveness of the tests determined the ordering of investigations, rather than the ranking of cancer risks. QCancer was seen as a potentially useful tool to reassure low cancer risk patients concerned about their symptoms, minimising possible over-investigation. The current presentation of QCancer cancer risks was too confronting to use in a consultation, especially for patients at increased risk of cancer, and had the potential to create significant loss of consultation control. Alternative formats involving diagnostic assessment guidance, rather than positive predictive values of cancer, would increase tool usage within a consultation.Conclusions: Implementation of cancer risk tools requires consideration of risk presentation to minimise the potential for confrontation within the consultation. Variable interpretation of patient histories and cancer risk estimates are a significant potential problem for implementing QCancer in practice. Professional experience and self-belief in clinical intuition influences tool usage. GPs need to recognise that problems exist in cancer diagnosis in primary care first before risk tools are to be used routinely.