{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T23:08:51Z","timestamp":1784070531990,"version":"3.55.0"},"reference-count":53,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T00:00:00Z","timestamp":1672876800000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health Research (NIHR) School for Primary Care Research","award":["208"],"award-info":[{"award-number":["208"]}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C12292\/A20861"],"award-info":[{"award-number":["C12292\/A20861"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C8640\/A23385"],"award-info":[{"award-number":["C8640\/A23385"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,12,15]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Abdominal symptoms are common in primary care but infrequently might be due to an upper gastrointestinal (UGI) cancer. Patients\u2019 descriptions may differ from medical terminology used by general practitioners (GPs). This may affect how information about abdominal symptoms possibly due to an UGI cancer are documented, creating potential missed opportunities for timely investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore how abdominal symptoms are communicated during primary care consultations, and identify characteristics of patients\u2019 descriptions that underpin variation in the accuracy and completeness with which they are documented in medical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Primary care consultation video recordings, transcripts and medical records from an existing dataset were screened for adults reporting abdominal symptoms. We conducted a qualitative content analysis to capture alignments (medical record entries matching patient verbal and non-verbal descriptions) and misalignments (symptom information omitted or differing from patient descriptions). Categories were informed by the Calgary-Cambridge guide\u2019s \u2018gathering information\u2019 domains and patterns in descriptions explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our sample included 28 consultations (28 patients with 18 GPs): 10 categories of different clinical features of abdominal symptoms were discussed. The information GPs documented about these features commonly did not match what patients described, with misalignments more common than alignments (67 vs 43 instances, respectively). Misalignments often featured patients using vague descriptors, figurative speech, lengthy explanations and broad hand gestures. Alignments were characterised by patients using well-defined terms, succinct descriptions and precise gestures for symptoms with an exact location. Abdominal sensations reported as \u2018pain\u2019 were almost always documented compared with expressions of \u2018discomfort\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Abdominal symptoms that are well defined or communicated as \u2018pain\u2019 may be more salient to GPs than those expressed vaguely or as \u2018discomfort\u2019. Variable documentation of abdominal symptoms in medical records may have implications for the development of clinical decision support systems and decisions to investigate possible UGI cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-058766","type":"journal-article","created":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T10:46:53Z","timestamp":1672915613000},"page":"e058766","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Agreement between patient\u2019s description of abdominal symptoms of possible upper gastrointestinal cancer and general practitioner consultation notes: a qualitative analysis of video-recorded UK primary care consultation data"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8620-4404","authenticated-orcid":false,"given":"Victoria","family":"Hardy","sequence":"first","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8501-2531","authenticated-orcid":false,"given":"Juliet","family":"Usher-Smith","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1349-7178","authenticated-orcid":false,"given":"Stephanie","family":"Archer","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Barnes","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Lancaster","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5274-6336","authenticated-orcid":false,"given":"Jon","family":"Emery","sequence":"additional","affiliation":[{"name":"Centre for Cancer Research and General Practice and Primary Care Academic Centre, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4419-8974","authenticated-orcid":false,"given":"Hardeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA"},{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7191-6476","authenticated-orcid":false,"given":"Fiona M","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"},{"name":"Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,1,5]]},"reference":[{"key":"2025121222381451000_13.1.e058766.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e6572"},{"key":"2025121222381451000_13.1.e058766.2","unstructured":"Committee on Diagnostic Error in Health Care; Institute of Medicine; The National Academies of Sciences, Engineering, and Medicine . Improving diagnosis in health care. National Academies Press (US), 2015: 1\u2013472."},{"key":"2025121222381451000_13.1.e058766.3","doi-asserted-by":"publisher","DOI":"10.1080\/01421590801953018"},{"key":"2025121222381451000_13.1.e058766.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2013.05.001"},{"key":"2025121222381451000_13.1.e058766.5","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1001\/jamainternmed.2013.2777","article-title":"Types and origins of diagnostic errors in primary care settings","volume":"173","author":"Singh","year":"2013","journal-title":"JAMA Intern Med"},{"key":"2025121222381451000_13.1.e058766.6","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9101100401"},{"key":"2025121222381451000_13.1.e058766.7","doi-asserted-by":"crossref","first-page":"e388","DOI":"10.1093\/pubmed\/fdx188","article-title":"The nature and frequency of abdominal symptoms in cancer patients and their associations with time to help-seeking: evidence from a national audit of cancer diagnosis","volume":"40","author":"Koo","year":"2018","journal-title":"J Public Health"},{"key":"2025121222381451000_13.1.e058766.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-018-4376-8","article-title":"Predictive values of upper gastrointestinal cancer alarm symptoms in the general population: a nationwide cohort study","volume":"18","author":"Rasmussen","year":"2018","journal-title":"BMC Cancer"},{"key":"2025121222381451000_13.1.e058766.9","unstructured":"National Institute for Health and Care Excellence . Gastrointestinal tract (upper) cancers - recognition and referral NG12. Available: https:\/\/cks.nice.org.uk\/topics\/gastrointestinal-tract-upper-cancers-recognition-referral\/ [Accessed 03 Aug 2021]."},{"key":"2025121222381451000_13.1.e058766.10","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s12325-020-01571-z","article-title":"Identifying novel biomarkers ready for evaluation in low-prevalence populations for the early detection of upper gastrointestinal cancers: a systematic review","volume":"38","author":"Calanzani","year":"2021","journal-title":"Adv Ther"},{"key":"2025121222381451000_13.1.e058766.11","unstructured":"National Cancer Intelligence Network . Routes to diagnosis 2006-2016 by year. Available: http:\/\/www.ncin.org.uk\/publications\/routes_to_diagnosis [Accessed 15 Jan 2021]."},{"key":"2025121222381451000_13.1.e058766.12","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S0140-6736(20)31099-0","article-title":"Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial","volume":"396","author":"Fitzgerald","year":"2020","journal-title":"Lancet"},{"key":"2025121222381451000_13.1.e058766.13","doi-asserted-by":"publisher","DOI":"10.1007\/s11017-015-9347-3"},{"key":"2025121222381451000_13.1.e058766.14","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-14-167","article-title":"Multiple perspectives on symptom interpretation in primary care research","volume":"14","author":"Rosendal","year":"2013","journal-title":"BMC Fam Pract"},{"key":"2025121222381451000_13.1.e058766.15","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1097\/00042737-200203000-00018","article-title":"Translating vague complaints into precise symptoms: the implications of a poor medical history","volume":"14","author":"Sonnenberg","year":"2002","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2025121222381451000_13.1.e058766.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-015682"},{"key":"2025121222381451000_13.1.e058766.17","doi-asserted-by":"publisher","DOI":"10.3399\/bjgpopen20X101001"},{"key":"2025121222381451000_13.1.e058766.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01772.x"},{"key":"2025121222381451000_13.1.e058766.19","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-020-01194-x"},{"key":"2025121222381451000_13.1.e058766.20","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.190"},{"key":"2025121222381451000_13.1.e058766.21","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.551"},{"key":"2025121222381451000_13.1.e058766.22","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp13X665215"},{"key":"2025121222381451000_13.1.e058766.23","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X683989"},{"key":"2025121222381451000_13.1.e058766.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2010-000025"},{"key":"2025121222381451000_13.1.e058766.25","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocy173"},{"key":"2025121222381451000_13.1.e058766.26","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0195"},{"key":"2025121222381451000_13.1.e058766.27","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1093\/jamia\/ocaa027","article-title":"How accurate is the medical record? A comparison of the physician\u2019s note with a concealed audio recording in unannounced standardized patient encounters","volume":"27","author":"Weiner","year":"2020","journal-title":"J Am Med Informatics Assoc"},{"key":"2025121222381451000_13.1.e058766.28","unstructured":"Barnes RK . One in a million: a study of primary care consultations. Bristol: University of Bristol, 2017. https:\/\/doi.org\/10.5523\/bris.l3sq4s0w66ln1x20sye7s47wv"},{"key":"2025121222381451000_13.1.e058766.29","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X690521"},{"key":"2025121222381451000_13.1.e058766.30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0127717"},{"key":"2025121222381451000_13.1.e058766.31","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.afjem.2017.08.001","article-title":"A hands-on guide to doing content analysis","volume":"7","author":"Erlingsson","year":"2017","journal-title":"Afr J Emerg Med"},{"key":"2025121222381451000_13.1.e058766.32","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305276687"},{"key":"2025121222381451000_13.1.e058766.33","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.npls.2016.01.001","article-title":"How to plan and perform a qualitative study using content analysis","volume":"2","author":"Bengtsson","year":"2016","journal-title":"NursingPlus Open"},{"key":"2025121222381451000_13.1.e058766.34","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.nedt.2017.06.002","article-title":"Methodological challenges in qualitative content analysis: a discussion paper","volume":"56","author":"Graneheim","year":"2017","journal-title":"Nurse Educ Today"},{"key":"2025121222381451000_13.1.e058766.35","unstructured":"Silverman J , Kurtz S , Draper J . Skills for communicating with patients. 3rd ed. CRC Press Taylor & Francis Group, 2013: 69\u2013130."},{"key":"2025121222381451000_13.1.e058766.36","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-15-105","article-title":"Complex consultations in primary care: a tool for assessing the range of health problems and issues addressed in general practice consultations","volume":"15","author":"Procter","year":"2014","journal-title":"BMC Fam Pract"},{"key":"2025121222381451000_13.1.e058766.37","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2923.1996.tb00724.x"},{"key":"2025121222381451000_13.1.e058766.38","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2019-009485"},{"key":"2025121222381451000_13.1.e058766.39","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1093\/jamia\/ocy155","article-title":"Clinicians' reasoning as reflected in electronic clinical note-entry and reading\/retrieval: a systematic review and qualitative synthesis","volume":"26","author":"Colicchio","year":"2019","journal-title":"J Am Med Inform Assoc"},{"key":"2025121222381451000_13.1.e058766.40","unstructured":"Mann C , Turner A , Salisbury C . The impact of remote consultations on personalised care evidence briefing commissioned by the personalised care Institute. Natl Inst Heal Res 2021:3\u201320."},{"key":"2025121222381451000_13.1.e058766.41","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00630.x"},{"key":"2025121222381451000_13.1.e058766.42","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.408"},{"key":"2025121222381451000_13.1.e058766.43","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2011-000310"},{"key":"2025121222381451000_13.1.e058766.44","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.1038\/bjc.2015.47","article-title":"Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation","volume":"112 Suppl 1","author":"Lyratzopoulos","year":"2015","journal-title":"Br J Cancer"},{"key":"2025121222381451000_13.1.e058766.45","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-020-0947-y"},{"key":"2025121222381451000_13.1.e058766.46","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2015-000376"},{"key":"2025121222381451000_13.1.e058766.47","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1038\/s41416-020-0828-4","article-title":"Assessing patients at risk of symptomatic-but-as-yet-undiagnosed cancer in primary care using information from patient records","volume":"122","author":"Lyratzopoulos","year":"2020","journal-title":"Br J Cancer"},{"key":"2025121222381451000_13.1.e058766.48","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2020.0697"},{"key":"2025121222381451000_13.1.e058766.49","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.ejon.2019.06.007","article-title":"Understanding primary care nurses' contribution to cancer early diagnosis: a systematic review","volume":"41","author":"Skrobanski","year":"2019","journal-title":"Eur J Oncol Nurs"},{"key":"2025121222381451000_13.1.e058766.50","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X685621"},{"key":"2025121222381451000_13.1.e058766.51","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp12X616355"},{"key":"2025121222381451000_13.1.e058766.52","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp11X606609"},{"key":"2025121222381451000_13.1.e058766.53","unstructured":"98point6 . On-demand, text-based primary care [Internet]. Available: https:\/\/www.98point6.com\/ [Accessed 06 Oct 2021]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-058766","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:38:25Z","timestamp":1765607905000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-058766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,5]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1136\/bmjopen-2021-058766"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-058766","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}