Patient perspectives on the impact of an initial non-cancer diagnosis prior to a subsequent cancer diagnosis: a secondary qualitative analysis.

Background Timely diagnosis of cancer can be challenging as most present with non-specific symptoms in primary care. A third of those diagnosed with cancer report receiving a non-cancer diagnosis, before being referred for cancer investigations ('interim' diagnosis), presenting a potential missed diagnostic opportunity. Aim This study explored patients' experiences of receiving a non-cancer diagnosis prior to referral for investigation for suspected cancer. Design and Setting Secondary qualitative analysis of seven interview datasets collected in primary care in the UK since 2015. Method Patient journeys were summarised, charted and analysed using framework analysis. Patient Public Involvement and Engagement collaborators were involved throughout. Results 58 transcripts were included in which the patient presented to primary care with symptoms and received an interim non-cancer diagnosis. We identified eight common scenarios involving an initial non-cancer diagnosis followed by referral for suspected cancer. For example, individuals considered at low risk of cancer reported symptoms being linked to lifestyle factors, requiring multiple contacts over time before further investigation was considered. Patients queried interim diagnoses when they felt their symptoms and interpretations had been poorly understood, or they had been given inappropriate investigations or ineffective treatment. While patients recognised the difficulty of deciding when common symptoms required onward referral, they trusted clinicians who were responsive to their concerns, regardless of outcome. Conclusion Interim diagnoses arise as part of the normal diagnostic process in patients presenting with non-specific symptoms. Challenging these diagnoses in the face of new evidence could mitigate potential delays in diagnosis and improve patient outcomes.