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How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis
  1. Michael Harris1,2,
  2. Hans Thulesius3,4,
  3. Ana Luísa Neves5,6,
  4. Sophie Harker1,
  5. Tuomas Koskela7,
  6. Davorina Petek8,
  7. Robert Hoffman9,
  8. Mette Brekke10,
  9. Krzysztof Buczkowski11,
  10. Nicola Buono12,
  11. Emiliana Costiug13,
  12. Geert-Jan Dinant14,
  13. Gergana Foreva15,
  14. Eva Jakob16,
  15. Mercè Marzo-Castillejo17,
  16. Peter Murchie18,
  17. Jolanta Sawicka-Powierza19,
  18. Antonius Schneider20,
  19. Emmanouil Smyrnakis21,
  20. Sven Streit2,
  21. Gordon Taylor22,
  22. Peter Vedsted23,
  23. Birgitta Weltermann24,
  24. Magdalena Esteva25
  1. 1Department for Health, University of Bath, Bath, UK
  2. 2Berner Institut für Hausarztmedizin (BIHAM), University of Bern, Bern, Switzerland
  3. 3Department of Clinical Sciences, Lund University, Lund, Sweden
  4. 4Department of Research and Development, Region Kronoberg, Sweden
  5. 5Institute of Global Health Innovation, Imperial College London, London, UK
  6. 6CINTESIS (Centre for Health Technology and Services Research) and MEDCIDS (Department of Community Medicine, Information and Health Decision Sciences), Faculty of Medicine, University of Porto, Porto, Portugal
  7. 7Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  8. 8Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
  9. 9Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
  10. 10Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway
  11. 11Department of Family Medicine, Nicolaus Copernicus University, Toruń, Poland
  12. 12Department of General Practice, National Society of Medical Education in General Practice (SNaMID), Caserta, Italy
  13. 13Family Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
  14. 14Department of General Practice, Maastricht University, Maastricht, The Netherlands
  15. 15Medical Center BROD, Plovdiv, Bulgaria
  16. 16Primary Health Centre, Centro de Saúde Sarria, Sarria, Lugo, Spain
  17. 17Unitat de Suport a la Recerca, IDIAP Jordi Gol, Institut Català de la Salut, Barcelona, Spain
  18. 18Division of Applied Health Sciences - Academic Primary Care, University of Aberdeen, Aberdeen, UK
  19. 19Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland
  20. 20TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, München, Germany
  21. 21Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
  22. 22College of Medicine and Health, University of Exeter, Exeter, UK
  23. 23Research Unit for General Practice, Aarhus University, Aarhus, Denmark
  24. 24Institut für Hausarztmedizin, University of Bonn, Bonn, Germany
  25. 25Research Unit, Majorca Primary Health Care Department, Balearic Islands Health Research Institute (IdISBa), Preventive Activities and Health Promotion Network, Carlos III Institute of Health (RedIAPP-RETICS), Palma de Mallorca, Spain
  1. Correspondence to Professor Michael Harris; michaelharris681{at}


Background National European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis.

Objectives This study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagnosis could be improved.

Design In an online survey, a final open-ended question asked PCPs how they thought the speed of diagnosis of cancer in primary care could be improved. Thematic analysis was used to analyse the data.

Setting A primary care study, with participating centres in 20 European countries.

Participants A total of 1352 PCPs answered the final survey question, with a median of 48 per country.

Results The main themes identified were: patient-related factors, including health education; care provider-related factors, including continuing medical education; improving communication and interprofessional partnership, particularly between primary and secondary care; factors relating to health system organisation and policies, including improving access to healthcare; easier primary care access to diagnostic tests; and use of information technology. Re-allocation of funding to support timely diagnosis was seen as an issue affecting all of these.

Conclusions To achieve more timely cancer diagnosis, health systems need to facilitate earlier patient presentation through education and better access to care, have well-educated clinicians with good access to investigations and better information technology, and adequate primary care cancer diagnostic pathway funding.

  • Delivery of Health Care
  • Primary Health Care
  • General Practitioners
  • Cancer
  • Diagnosis
  • Consultation and Referral

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  • Correction notice This article has been corrected since it was published. Author name has been updated.

  • Contributors KB, MB, NB, EC, G-JD, ME, GF, EJ, MH, RH, EJ, TK, MM-C, PM, ALN, DP, JS-P, AS, ES, SS, HT, PV and BW participated in the study design, piloting and data collection. GT participated in the study design. SH coded some of the data. ME and SH assisted in validated the coding. ME, MH, RH, TK, ALN, DP and HT worked together to agree the themes. MH had overall responsibility for the study design, recruitment of local leads, analysis of data and interpretation of results. All authors contributed to the writing and review of the manuscript and approved the final version.

  • Funding This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. ALN is supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre, with infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study was given by the University of Bath Research Ethics Approval Committee for Health (approval date: 24 November 2014; REACH reference number: EP 14/15 66). Other countries’ study leads either achieved local ethical approval or gave statements that formal ethical approval was not needed in their jurisdictions.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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