Table 3 Criteria taken into consideration by panel in assessing each event in the pathway
Initial diagnostic assessment | Diagnostic test performance and interpretation | Diagnostic follow up and consultation | ||
|---|---|---|---|---|
Primary care | Secondary care | |||
Patient | Language. Geography. Comorbidity. Psycho-social factors. | Non adherence | Passive/Active FU of results. Unsafe-safety netting. Inconsistent symptoms or resolution of symptoms. | Passive/Active FU of results. Unsafe-safety netting. Inconsistent symptoms or resolution of symptom |
Healthcare Professional | Inadequate history and/or examination. Cognitive factors, unfamiliarity with cancer presentation. Comorbidities. Referral norms. Continuity of care. | Misinterpretation of results, false negative. Lack/delay of FU of results. Deficient investigation strategy/wrong test. Communication. | Over reliance on patient to re-present. Timely FU. Communication. Coordination failures. Lack of appreciation or FU of abnormal test result. Continuity of care. | Over reliance on patient to re-present. Timely FU. Communication. Coordination failures. Lack of appreciation or FU of abnormal test result. Continuity of care. |
System | Rigid consultation norms. Access/system capacity constraints. Access to diagnostic tests. Administrative failure in booking | Lack of system to deal with failure to attend. Diagnostic testing process complexity. Lack of ownership of results. | Accountability for the patient as they progress through the diagnostic pathway. | Accountability for the patient as they progress through the diagnostic pathway. |
Disease | Atypical symptoms and/or presentation. | False negatives. | ||