Clinical decision making and risk appraisal using electronic risk assessment tools for cancer diagnosis: a qualitative study of GP experiences.

Abstract

Background: Electronic risk assessment tools (eRATs) are intended to improve early primary care cancer diagnosis. eRATs, which interrupt a consultation to suggest a possibility of a cancer diagnosis, could impact clinical appraisal and the experience of the consultation. This study explores this issue using data collected within the context of the Electronic RIsk-assessment for CAncer (ERICA) trial.

Aim: To explore views and experiences of GPs who used the ERICA eRATs, how the tools impacted their perception of risk and diagnostic thinking, and how this was communicated to patients.

Design & setting: Qualitative interviews with GPs from English general practices undertaking the ERICA trial.

Method: Participants were purposefully sampled from practices participating in the intervention arm of the ERICA trial. Eighteen GPs undertook semi-structured interviews via Microsoft Teams. Thematic analysis was used to explore their perspectives of the impact of the eRATs on consultations, diagnostic thinking related to cancer and other conditions, and how this information is communicated to patients.

Results: The following three themes were developed: 1) the armoury, whereby eRATs were perceived as 'additional armour', offering a layer of protection against missing a cancer diagnosis, the defence coming at a cost of anxiety and complexity of consultation; 2) 'three heads' making a decision. eRATs were seen as another actor in the consultation, separate from clinician and patient, and challenging GP autonomy; and 3) for whom is the eRAT output intended? GPs were conflicted about whether the numerical eRAT outputs were helpful when communicating with patients.

Conclusion: eRATs are appreciated as a defence against missing a cancer diagnosis. This defence comes at a cost and challenges GPs' freedom in communication and decision making.