Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care

• Published in: BMC Health Services Research
• Main Authors: Cecilia Hultstrand, Anna-Britt Coe, Mikael Lilja, Senada Hajdarevic
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2020
• Subjects: Interaction; Negotiation; Access; Primary healthcare; Cancer; Standardized care pathways; Public aspects of medicine; RA1-1270; Northern Sweden
• Online Access: https://doi.org/10.1186/s12913-020-4893-4; https://doaj.org/article/f073df47b6eb4e3f8fc75e1c2dff8def

Abstract Background How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). Methods Participant observations of patient-provider encounters (n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. Results One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. Conclusions Patients and GPs seem to be mutually ...