Language
English
Publication Date
8-1-2023
Journal
British Journal of General Practice
DOI
10.3399/BJGP.2022.0602
PMID
37253628
PMCID
PMC10242858
PubMedCentral® Posted Date
5-31-2023
PubMedCentral® Full Text Version
Post-print
Abstract
Background: Patients with bladder and kidney cancer may experience diagnostic delays.
Aim: To identify patterns of suboptimal care and contributors of potential missed diagnostic opportunities (MDOs).
Design and setting: Prospective, mixed-methods study recruiting participants from nine general practices in Eastern England between June 2018 and October 2019.
Method: Patients with possible bladder and kidney cancer were identified using eligibility criteria based on National Institute for Health and Care Excellence (NICE) guidelines for suspected cancer. Primary care records were reviewed at recruitment and at 1 year for data on symptoms, tests, referrals, and diagnosis. Referral predictors were examined using logistic regression. Semi-structured interviews were undertaken with 15 patients to explore their experiences of the diagnostic process, and these were analysed thematically.
Results: Participants (n = 940) were mostly female (n = 657, 69.9%), with a median age of 71 years (interquartile range 64-77 years). In total, 268 (28.5%) received a referral and 465 (48.5%) had a final diagnosis of urinary tract infection (UTI). There were 33 (3.5%) patients who were diagnosed with cancer, including prostate (n = 17), bladder (n = 7), and upper urothelial tract (n = 1) cancers. Among referred patients, those who had a final diagnosis of UTI had the longest time to referral (median 81.5 days). Only one-third of patients with recurrent UTIs were referred despite meeting NICE referral guidelines. Qualitative findings revealed barriers during the diagnostic process, including inadequate clinical examination, female patients given repeated antibiotics without clinical reviews, and suboptimal communication of test results to patients.
Conclusion: Older females with UTIs might be at increased risk of MDOs for cancer. Targeting barriers during the initial diagnostic assessment and follow-up might improve quality of diagnosis.
Keywords
Male, Humans, Female, Middle Aged, Aged, Urinary Bladder, Prospective Studies, Kidney Neoplasms, Urinary Tract Infections, England, bladder cancer, early diagnosis of cancer, kidney cancer, missed opportunities, primary health care
Published Open-Access
yes
Recommended Citation
Zhou, Yin; Singh, Hardeep; Hamilton, Willie; et al., "Improving the Diagnostic Process for Patients With Possible Bladder and Kidney Cancer: A Mixed-Methods Study to Identify Potential Missed Diagnostic Opportunities" (2023). Faculty and Staff Publications. 4551.
https://digitalcommons.library.tmc.edu/baylor_docs/4551