Verbatim quotations from the qualitative study and open responses from the cross-sectional survey
| Theme | Subtheme | Verbatim quotation |
| Challenges of diagnosis | Fear of missing GCA and non-specific presentation | “an elderly lady who was having headaches and kind of pain around her eyes and I’m trying to think what other symptoms she had, general misery really. And it sort of came and went and came and went and she didn’t really have any visual problems which is good and when you said to her, ‘Does it hurt to chew?’ she’d say, ‘Oh yes I think it does’. And so yes all of that so in the end I started, I did discuss it with our local physicians because just in that situation where you don’t want to miss it but on the other hand it doesn’t seem like it’s probably the most likely diagnosis. And we got as far as them saying, ‘Well if it’s maybe a possibility then go ahead and treat with steroids’, at which point she said, ‘No I’m feeling much better thank you’. And that was that until she started complaining about it again another few months later.” GP17 (11, F, P) |
| Initial and ongoing treatment and monitoring | Starting treatment | “And, certainly, in the past couple of years, we’ve started them on steroids first, because, kind of, getting anybody to see them quickly, you know, within a day or two, not been possible, which doesn’t seem very ideal to me. And we’ve taken the view if it turns out to be wrong, we can stop it, but if we don’t start it, there might be a problem before they get the biopsy. So that’s, kind of, what we’ve done here.” GP15 (25, F, P) |
| “Yes again just I think in terms of the ongoing management really because my experience with another patient, the one that ended up with visual disturbance, she sort of then fell between ophthalmology and rheumatology without either necessarily taking full responsibility for her and actually she was a patient of a partner of mine so he was kind of following her up but his experience was that he was piggy in the middle really.” GP 6 (20, F, P) | ||
| Expediency of review | “you refer them under a two week wait, and it’s not that much of an emergency, whereas we all thought you referred them acutely, because it was that much of an emergency. So there was a big discrepancy of views between what we felt we’d been taught about it, and what other people were now doing.” GP23 (12, F, S) | |
| “I know we, kind of, all get it drummed into us, you know, we should all get these things sent in on the day. But I think, well, one of them was hanging round for a year, and he didn’t really come to any harm, except undue pain and distress that he had. And the other one was hanging round for a couple of months, you know. And they were both proved—as I say, I’m turning the clock back 15 years—but I think they were both proven to be temporal arteritis. It maybe isn’t that, kind of, you know, you must get them in on the day, as I thought as a medical student, you know.” GP22 (15, M, P) | ||
| Challenges with referral for definitive diagnostic confirmation by specialist | Delays in temporal artery biopsy | “The patient that I referred on the NHS, she ended up having a biopsy before she saw a consultant rheumatologist. So, yes, it was done that way round. The biopsy, of course, came back negative because the two week delay before getting it done meant the steroids had treated it.” GP21 (7, F, S) |
| “Local issue regarding whether ophthalmology or vascular surgery will perform temporal artery biopsy, reliability of this procedure and steroid response whilst waiting for the biopsy.” Participant 2506 (4, 2, P) |
Key to participant demographic: GP (n) (qualitative study identifier), Participant (n) (survey identifier) (time qualified as a GP (years), gender (Male/Female), seniority/role (S, salaried; P, partner)).
GCA, giant cell arteritis; GP, general practitioner.