Factors shaping the implementation and use of Clinical Cancer Decision Tools by GPs in primary care: a qualitative framework synthesis

Bradley, Paula Theresa, Hall, Nicola, Maniatopoulos, Gregory, Neal, Richard D, Paleri, Vinidh and Wilkes, Scott (2021) Factors shaping the implementation and use of Clinical Cancer Decision Tools by GPs in primary care: a qualitative framework synthesis. BMJ Open, 11 (2). e043338. ISSN 2044-6055

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Official URL: https://doi.org/10.1136/bmjopen-2020-043338

Abstract

Objective: Clinical Cancer Decision Tools (CCDTs) aim to alert general practitioners (GPs) to signs and symptoms of cancer, supporting prompt investigation and onward referral. CCDTs are available in primary care in the UK but are not widely utilised. Qualitative research has highlighted the complexities and mechanisms surrounding their implementation and use; this has focused on specific cancer types, formats, systems or settings. This study aims to synthesise qualitative data of GPs’ attitudes to and experience with a range of CCDTs to gain better understanding of the factors shaping their implementation and use. Design: A systematic search of the published (MEDLINE, CINAHL, Web of Science and EMBASE) and grey literature (July 2020). Following screening, selection and assessment of suitability, the data were analysed and synthesised using normalisation process theory. Results: Six studies (2011 to 2019), exploring the views of GPs were included for analysis. Studies focused on the use of several different types of CCDTs (Risk Assessment Tools (RAT) or electronic version of RAT (eRAT), QCancer and the 7-point checklist). GPs agreed CCDTs were useful to increase awareness of signs and symptoms of undiagnosed cancer. They had concerns about the impact on trust in their own clinical acumen, whether secondary care clinicians would consider referrals generated by CCDT as valid and whether integration of the CCDTs within existing systems was achievable. Conclusions: CCDTs might be a helpful adjunct to clinical work in primary care, but without careful development to legitimise their use GPs are likely to give precedence to clinical acumen and gut instinct. Stakeholder consultation with secondary care clinicians and consideration of how the CCDTs fit into a GP consultation are crucial to successful uptake. The role and responsibilities of a GP as a clinician, gatekeeper, health promoter and resource manager affect the interaction with and implementation of innovations such as CCDTs.

Item Type: Article
Uncontrolled Keywords: General practice / Family practice, 1506, 1696, primary care, oncology, qualitative research
Subjects: A300 Clinical Medicine
A900 Others in Medicine and Dentistry
B100 Anatomy, Physiology and Pathology
B200 Pharmacology, Toxicology and Pharmacy
B900 Others in Subjects allied to Medicine
Department: Faculties > Business and Law > Newcastle Business School
Depositing User: Rachel Branson
Date Deposited: 23 Feb 2021 09:45
Last Modified: 31 May 2021 14:42
URI: http://nrl.northumbria.ac.uk/id/eprint/45512

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