Why do European Primary Care Physicians sometimes not think of, or act on, a possible cancer diagnosis?

Tuomas Koskela, Marija Petek Ster, Magdalena Esteva, Merce Marzo, Davorina Petek, Senada Hajdarevic, Vija Silina, Sara Contreras, Cecilia Högberg, Liina Pilv, Jolanta Sawicka-Powierza, Marcello Mangione, Michael Harris

Keywords: The Örenäs Study, cancer, diagnosis, early diagnosis


Primary care (PC) is often an entrance when suspecting cancer. Primary Care Physicians (PCPs) see patients whose symptoms are non-specific and common. The symptoms can be explained by cancer, but cancer is rarely the cause. Cancer diagnosis in PC represents a high-risk area for errors. Knowledge of diagnostic errors could be used to encourage and promote learning. To our knowledge, there is little evidence on PCPs’ experiences of failures in cancer diagnosis. This study aims to explore the pitfalls of cancer diagnosis in primary care.

Research questions:

Why European GPs sometimes fail to think of, or act on, a possible cancer diagnosis?


A qualitative international study using online survey with open questions asking for case narratives from PCPs about this topic. The study will be carried out in at least 25 European countries by the Örenäs Study Group. Subjects will be eligible for the study if they are working as PCPs. A purposive sample of PCPs will be recruited in each country by an Örenäs group national lead. The target will be to recruit at least 5 physicians per country and a maximum of 10 including both genders and PCPs with varying experience. The respondents will be asked to describe a case according to the questions agreed as a result of a pilot study. In order to preserve patient anonymity, the PCPs will be asked to describe the cases in such a way that the identity of the patient cannot be deduced. We will use thematic analyses to analyse data. At least three members of the Örenäs group will make the initial coding separately and then compare their coding results in skype meetings. Combining codes into the themes will be made at a face to face meeting of the Örenäs group members.



Points for discussion:

What kind of challenges do you see in this study?