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

Abstract

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

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

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

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

Results: Fifteen nonconsulters and 17 consulters were interviewed. Nonconsulters were more likely to belong to disadvantaged and ethnic communities. There was little variation between patient groups in their experiences and perceptions regarding pain intensity and related distress and ED's advantages in terms of accessibility and convenience. Cancer fear, uncertainty about symptoms, and frustration in accessing PC due to language barriers were unique among nonconsulters, leading to help-seeking delays. Patients' perception of the ED as a facility providing high-quality care and 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 PC and the ED. Increasing awareness and developing community-based programs that target cancer fear and fatalism may encourage early presentation to PC, especially among underrepresented and ethnic minority groups.