The two-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.

A study published in the British Journal of General Practice found that the failure to be seen within two weeks of urgent referral resulted from a number of patient and provider factors. It concluded that the urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.

In-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis to examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance.

In this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis.

GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.

More time needed with patients in appointments

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "It's concerning to hear that even a small proportion of patients are not attending their 'two-week wait' referral appointments for suspected cancer. If patients are seen quickly when cancer is suspected, it can have a significant positive impact on their treatment and the eventual outcome.

"GPs are highly skilled communicators who will always try to strike the difficult balance of conveying to patients the importance of attending two week wait referral appointments, without causing them undue worry and anxiety.

"We are highly trained to have difficult conversations, but we need more time with our patients and the traditional 10-minute appointment is increasingly unfit for purpose. This research provides further evidence to support the College's calls for 15-minute appointments as standard for our patients with complex needs.

"Meanwhile, we would urge any patient who cannot attend their two week wait referral appointment to contact the hospital to arrange an alternative date as a matter of urgency, and, if at all possible, within two weeks of seeing their GP."