{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T22:32:35Z","timestamp":1779143555194,"version":"3.51.4"},"reference-count":43,"publisher":"Royal College of General Practitioners","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"accepted":{"date-parts":[[2025,1,31]]},"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Some patients are diagnosed with cancer following self-referral to the emergency department (ED), even after consulting in primary care; however, the rationale and factors involved in the decision to self-refer are largely unknown.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Aim<\/jats:title>\n<jats:p>To explore patients\u2019 perceptions on reasons for emergency self-referral shortly before a cancer diagnosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Design &amp; setting<\/jats:title>\n<jats:p>Qualitative interview study at a high-volume public institution in Barcelona.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Method<\/jats:title>\n<jats:p>Semi-structured interviews were conducted with two patient groups: patients who self-referred as emergencies and never consulted primary care (non-consulters), and patients who self-referred despite consulting primary care (consulters). Data were analysed by two independent coders \u2014 an emergency doctor and a primary care physician \u2014 using a codebook approach to thematic analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Fifteen non-consulters and 17 consulters were interviewed. Non-consulters were more likely to belong to disadvantaged and minoritised ethnic communities. Reasons why participants self-referred to the ED were categorised under four themes: urgency\/distress, advantages of the ED, quality care, and access to primary care. There was little variation between patient groups in their experiences and perceptions regarding pain intensity and related distress, and EDs\u2019 advantages in terms of accessibility and convenience. Cancer fear, uncertainty about symptoms, and frustration in accessing primary care due to language barriers were unique among non-consulters, leading to help-seeking delays. Patients\u2019 perception of the ED as a facility that provides high-quality care and is able to meet all medical needs emerged as a distinct theme among consulters.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Healthcare organisations and public health services bear the responsibility to promote patient education and improve communication regarding the specific roles and purposes of primary care and the ED. Increasing awareness and developing community-based programmes that target cancer fear and fatalism may encourage early presentation to primary care, especially among underrepresented and minoritised ethnic groups.Delete<\/jats:p>\n<\/jats:sec>","DOI":"10.3399\/bjgp.2024.0355","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T09:05:14Z","timestamp":1741165514000},"page":"BJGP.2024.0355","source":"Crossref","is-referenced-by-count":1,"title":["Patients\u2019 perceptions on reasons for self-referring to the emergency department shortly before a cancer diagnosis: a qualitative study"],"prefix":"10.3399","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8157-541X","authenticated-orcid":false,"given":"Xavier","family":"Bosch","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabet","family":"Montori-Palacin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Moreno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana-Maria","family":"Guio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1987","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"2025081110350535000_BJGP.2024.0355v2.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(22)00127-9"},{"issue":"1","key":"2025081110350535000_BJGP.2024.0355v2.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-018-3476-0","article-title":"The aarhus statement on cancer diagnostic research: turning recommendations into new survey instruments","volume":"18","author":"Coxon","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"2025081110350535000_BJGP.2024.0355v2.3","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X690869"},{"key":"2025081110350535000_BJGP.2024.0355v2.4","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp19X705473"},{"key":"2025081110350535000_BJGP.2024.0355v2.5","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2017.71"},{"key":"2025081110350535000_BJGP.2024.0355v2.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2010.11.029"},{"key":"2025081110350535000_BJGP.2024.0355v2.7","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2016.155"},{"issue":"8","key":"2025081110350535000_BJGP.2024.0355v2.8","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.2217\/fon.14.80","article-title":"Are emergency diagnoses of cancer avoidable? a proposed taxonomy to motivate study design and support service improvement","volume":"10","author":"Lyratzopoulos","year":"2014","journal-title":"Future Oncol"},{"key":"2025081110350535000_BJGP.2024.0355v2.9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0135027"},{"issue":"1","key":"2025081110350535000_BJGP.2024.0355v2.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-018-4287-8","article-title":"Negative cancer beliefs, recognition of cancer symptoms and anticipated time to help-seeking: an international cancer benchmarking partnership (ICBP) study","volume":"18","author":"Pedersen","year":"2018","journal-title":"BMC Cancer"},{"key":"2025081110350535000_BJGP.2024.0355v2.11","unstructured":"Koo MM (2018) The presenting symptoms of cancer patients and associations with diagnostic timeliness (University College London), accessed. https:\/\/discovery.ucl.ac.uk\/id\/eprint\/10053161\/1\/Koo_10053161_thesis.Redacted.pdf. 8 Jul 2025."},{"key":"2025081110350535000_BJGP.2024.0355v2.12","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp15X683533"},{"key":"2025081110350535000_BJGP.2024.0355v2.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-015682"},{"key":"2025081110350535000_BJGP.2024.0355v2.14","doi-asserted-by":"publisher","DOI":"10.3399\/bjgpopen20X101001"},{"issue":"3","key":"2025081110350535000_BJGP.2024.0355v2.15","first-page":"1","article-title":"Spain: health system review","volume":"26","author":"Bernal-Delgado","year":"2024","journal-title":"Health Syst Transit"},{"key":"2025081110350535000_BJGP.2024.0355v2.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2363"},{"key":"2025081110350535000_BJGP.2024.0355v2.17","unstructured":"Centro de Investigaciones Sociol\u00f3gicas (Centre for Sociological Research) (2023) Bar\u00f3metro sanitario 2023 (tercera oleada): distribuciones marginales. 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