Cavers Debbie, Duff Rhona, Bikker Annemieke, Barnett Karen, Kanguru Lovney, Weller David, Brewster David H, Campbell Christine
Usher Institute of Population Health Sciences, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
BMC Cancer. 2021 May 3;21(1):496. doi: 10.1186/s12885-021-08238-0.
More people are surviving a first primary cancer and experiencing a second, different cancer. However, little is known about the diagnostic journeys of patients with second primary cancer (SPC). This study explores the views of patients and general practitioners (GPs) on their experiences of pathways to diagnosis of SPC, including the influence of a previous diagnosis of cancer on symptom appraisal, help-seeking and referral decisions.
Qualitative interviews with patients with a SPC diagnosis and case-linked GP interviews in a Scottish primary care setting. In-depth face to face or telephone interviews were conducted, underpinned by a social constructionist approach. Interviews were transcribed and Braun and Clarke's thematic analysis undertaken. Three analysts from the research team read transcripts and developed the coding framework using QSR NVivo version 10, with input from a fourth researcher. Themes were developed from refined codes and interpreted in the context of existing literature and theory.
Interviews were conducted with 23 patients (aged 43-84 years) with a SPC diagnosis, and 7 GPs. Five patient themes were identified: Awareness of SPC, symptom appraisal and help-seeking, pathways to diagnosis, navigating the healthcare system, and impact of SPC. GPs interviews identified: experience and knowledge of SPC and referrals and decision-making.
Insights into the pathway to diagnosis of SPC highlights the need for increased awareness of and vigilance for SPC among patients and healthcare providers (HCPs), and emotional support to manage the psychosocial burden.
越来越多的人在首次原发性癌症中存活下来，并患上了第二种不同的癌症。然而，对于第二原发性癌症（SPC）患者的诊断过程却知之甚少。本研究探讨了患者和全科医生（GP）对SPC诊断途径的看法，包括先前癌症诊断对症状评估、寻求帮助和转诊决定的影响。
在苏格兰初级保健环境中，对患有SPC的患者进行定性访谈，并对与病例相关的全科医生进行访谈。采用社会建构主义方法，进行深入的面对面或电话访谈。访谈内容被转录，并采用布劳恩和克拉克的主题分析法进行分析。研究团队的三位分析师阅读了访谈记录，并使用QSR NVivo 10版本开发了编码框架，第四位研究人员也提供了意见。主题是从精炼的代码中发展而来，并在现有文献和理论的背景下进行解释。
对23名确诊为SPC的患者（年龄在43 - 84岁之间）和7名全科医生进行了访谈。确定了五个患者主题：对SPC的认识、症状评估与寻求帮助、诊断途径、在医疗系统中导航以及SPC的影响。全科医生访谈确定了：对SPC的经验和知识以及转诊与决策。
对SPC诊断途径的深入了解凸显了患者和医疗服务提供者（HCPs）提高对SPC的认识和警惕性的必要性，以及提供情感支持以应对心理社会负担的必要性。
