Primary healthcare providers' strategies of handling patients presenting with potential cancer symptoms following the introduction of standardized cancer patient pathways in Sweden.

Abstract

Background: Early cancer diagnosis is a healthcare priority, but identifying patients who may have cancer remains challenging because alarm symptoms are often non-specific and may also indicate other conditions. To facilitate timely cancer diagnosis, standardized cancer patient pathways (CPP) have been introduced in several health systems, including Sweden. Since most patients diagnosed with cancer begin their pathway in primary healthcare (PHC), nurses and physicians play a central role in assessing symptoms and determining whether CPP criteria for suspected cancer are fulfilled. Although research concerning the introduction of CPPs is expanding, knowledge is lacking on how CPPs influence Swedish PHC nurses' and physicians' ways of handling patients with potential cancer symptoms. Therefore, this study aimed to explore PHC providers' strategies of using CPPs when handling patients presenting symptoms that may indicate cancer.

Method: A constructivist Grounded Theory Method was utilized to collect and analyze qualitative data through group interviews in PHC units in northern Sweden. Six units were included, and nine group interviews were conducted from March to November 2019, involving 21 nurses and 20 physicians. Interviews were audio recorded, transcribed verbatim, and analyzed.

Results: The results showed a process of handling challenges and opportunities when suspecting cancer in PHC and using CPPs through three categories focusing on strategies. First, physicians and nurses prioritized patients' needs of urgent care through conviction by using their professional competence to assess symptoms, rather than strictly relying on the symptom descriptions outlined in CPPs, with nurses primarily identifying these symptoms. Second, while physicians used creative strategies to make CPP referrals work for patients whose symptoms did not align with the templates, nurses similarly used creative strategies to raise suspicions and facilitate further assessment despite the absence of clear alarm symptoms. Third, physicians and nurses sensitively informed patients about CPPs, balancing between explaining the next investigation steps and safeguarding potential illness-related anxiety by avoiding the discussion as much as possible.

Conclusion: Findings highlight the important role of PHC providers in using CPPs for patients with potential cancer by identifying symptoms, investigating suspicions, and sensitively informing patients. CPPs were perceived as facilitating faster cancer diagnostic pathways when they aligned with PHC providers' clinical assessments, but challenges arose when clinical assessments misalign with predetermined standardized packages. These findings indicate the importance of involving PHC providers in refining CPP usage. Furthermore, communicating clearly about potential cancer diagnoses is necessary, but not as simple as it may seem.