Patients' perceptions on reasons for self-referring to the emergency department shortly before a cancer diagnosis: a qualitative study.

Abstract

Background: Some patients are diagnosed with cancer following self-referral to the emergency department (ED), even after consulting in primary care; however, the rationale and factors involved in the decision to self-refer are largely unknown.

Aim: To explore patients' perceptions on reasons for emergency self-referral shortly before a cancer diagnosis.

Design & setting: Qualitative interview study at a high-volume public institution in Barcelona.

Method: Semi-structured interviews were conducted with two patient groups: patients who self-referred as emergencies and never consulted primary care (non-consulters), and patients who self-referred despite consulting primary care (consulters). Data were analysed by two independent coders - an emergency doctor and a primary care physician - using a codebook approach to thematic analysis.

Results: Fifteen non-consulters and 17 consulters were interviewed. Non-consulters were more likely to belong to disadvantaged and minoritised ethnic communities. Reasons why participants self-referred to the ED were categorised under four themes: urgency/distress, advantages of the ED, quality care, and access to primary care. There was little variation between patient groups in their experiences and perceptions regarding pain intensity and related distress, and EDs' advantages in terms of accessibility and convenience. Cancer fear, uncertainty about symptoms, and frustration in accessing primary care due to language barriers were unique among non-consulters, leading to help-seeking delays. Patients' perception of the ED as a facility that provides high-quality care and is able to meet all medical needs emerged as a distinct theme among consulters.

Conclusion: Healthcare organisations and public health services bear the responsibility to promote patient education and improve communication regarding the specific roles and purposes of primary care and the ED. Increasing awareness and developing community-based programmes that target cancer fear and fatalism may encourage early presentation to primary care, especially among underrepresented and minoritised ethnic groups.Delete.