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Br J Gen Pract. 2019 Apr;69(681):e224-e235. doi: 10.3399/bjgp19X701861. Epub 2019 Mar 11.

Missed opportunities for diagnosing brain tumours in primary care: a qualitative study of patient experiences.

Author information

1
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.
2
School of Clinical Medicine, Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge.
3
C/O University of Cambridge, Cambridge, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham.
4
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham.
5
University of Liverpool and Walton Centre NHS Trust, Liverpool.
6
Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge.
7
University of Exeter Medical School, Exeter.
8
Centre for Oral, Clinical and Translational Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London.

Abstract

BACKGROUND:

Brain tumours are uncommon, and have extremely poor outcomes. Patients and GPs may find it difficult to recognise early symptoms because they are often non-specific and more likely due to other conditions.

AIM:

To explore patients' experiences of symptom appraisal, help seeking, and routes to diagnosis.

DESIGN AND SETTING:

Qualitative study set in the East and North West of England.

METHOD:

In-depth interviews with adult patients recently diagnosed with a primary brain tumour and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework.

RESULTS:

Interviews were carried out with 39 patients. Few participants (n = 7; 18%) presented as an emergency without having had a previous GP consultation; most had had one (n = 15; 38%), two (n = 9; 23%), or more (n = 8; 21%) GP consultations. Participants experienced multiple subtle 'changes' rather than 'symptoms', often noticed by others rather than the patient, which frequently led to loss of interest or less ability to engage with daily living activities. The most common changes were in cognition (speaking, writing, comprehension, memory, concentration, and multitasking), sleep, and other 'head feelings' such as dizziness. Not all patients experienced a seizure, and few seizures were experienced 'out of the blue'. Quality of communication in GP consultations played a key role in patients' subsequent symptom appraisal and the timing of their decision to re-consult.

CONCLUSION:

Multiple subtle changes and frequent GP visits often precede brain tumour diagnosis, giving possible diagnostic opportunities for GPs. Refined community symptom awareness and GP guidance could enable more direct pathways to diagnosis, and potentially improve patient experiences and outcomes.

KEYWORDS:

central nervous system neoplasms; diagnosis; primary brain neoplasms; primary care; symptoms

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