Abstract
Background:
Primary care nurses (PCNs) play an important role in cancer early diagnosis. However, little research has examined if, or how, PCNs’ contribution to this field can be optimised.
Aims:
1. To understand UK PCNs’ performance of cancer early diagnosis practices (i.e. recognition and response to cancer warning signs, discussions about warning signs and screening programmes).
2. To determine the barriers and facilitators to UK PCNs carrying out cancer early diagnosis practices.
Methods:
Following a systematic review of published international research (n=22 studies), an explanatory sequential mixed-methods design was adopted. Phase 1 was a secondary analysis of survey data from PCNs (n=393). In phase 2, semi-structured telephone interviews (n=20) were conducted with PCNs to augment the survey findings. Findings were integrated to determine whether the two datasets supported, or expanded upon, each other (phase 3) using the COM-B model as an analytical framework. Lastly, two focus groups were conducted with PCNs (n=12) to determine views about the findings, and recommendations for enhancing their professions’ role in this field.
Main results and discussion:
Most PCNs reported regularly discussing cancer signs/symptoms, and cervical and breast screening with patients, but only a minority reported regularly discussing bowel screening. Across the research phases, barriers and facilitators to performing cancer early diagnosis practices are described according to domains of the COM-B model, including: variability in knowledge, diagnostic skills and confidence (capability-related); beliefs about the PCN role, consequences for patients, and doctor’s expectations (motivation-related); and opportunities for nurses to act on patients concerns by involving doctors or referring to secondary care (opportunity-related). Contextual influences included nurse seniority,
experience, and practice size and location. PCNs are generally well-positioned and motivated to help diagnose cancer earlier. This thesis provides recommendations on how to capitalise on this rich resource, and untapped opportunity, for PCNs to help save lives from cancer.