Developing a framework to understand GPs referral decisions for younger patients with cancer symptoms

Cancer diagnosis in younger patients is problematic. As cancer is rare before the age of 50, NICE referral guidelines use patients’ age as one of the criteria to help deciding who should be referred via the fast track cancer pathway. Consequently, younger patients may have to visit their GP several times before being referred for cancer tests, and/or they may be referred through a less urgent route, which could result in a delayed diagnosis.

Core CanTest faculty member Dr Erica di Martino is currently leading a research project at the University of Leeds looking into whether these guidelines may need reviewing, in view of the fact that some cancers are becoming more frequent in younger people, possibly due to risk factors, such as obesity, being more common today than in the past. As part of the project (Cancer referral in younger patients – do age threshold guidelines need updating?), GPs across England have been interviewed to understand how they interpret and apply the referral guidelines when consulted by a younger patient with symptoms that may be due to cancer.

Dr di Martino explains more about her research techniques here:

Analysis and interpretation of interview data is very different from numerical data and requires special training in techniques such as the Framework approach. Recently, I was very fortunate to be awarded a CanTest travelling fellowship that allowed me to attend a course on qualitative data analysis organised by the Social Research Association  and delivered by experienced researchers from NatCen, the research organisation where the Framework approach was originally developed. During the 3-day intensive training, which used a mixture of taught sessions and practical exercises, I learned the fundamentals for a robust and reproducible qualitative analysis including effective management of data and how to search for linkage and typologies within the dataset. I also learned some time-saving practical skills, for example how to automatically export data from the analysis software NVivo into a matrix format.

The CanTest travelling fellowship also allowed me to visit Prof. Suzanne Scott at London’s Queen Mary University, who is a leading expert in this type of analysis.  Over the course of three visits, Suzanne helped me gain a deep understanding of my dataset and develop a framework for the analysis. Equipped with this knowledge, I am now making good progress with the analysis of the interviews, which are proving extremely insightful on GP’s interpretation, views and application of cancer referral guidelines and their decision-making processes when consulted by younger patients with symptoms suggestive of cancer. The results of the study are expected to be published later this year.