چکیده (انگلیسی):

Background:Abdominal complaints are common reasons for contacting primary care physicians, and it can be
challenging for general practitioners (GPs) to identify patients with suspected colorectal cancer (CRC) for referral to
secondary care. The immunochemical faecal occult blood test (iFOBT) is used as a diagnostic aid in primary care,
but it is unclear how test results are interpreted. Studies show that negative tests are associated with a risk of
delayed diagnosis of CRC and that some patients with positive tests are not investigated further. The aim of this
study was to explore what makes GPs suspect CRC and to investigate their practices regarding investigation and
referral, with special attention on the use of iFOBTs.
Method:Semi-structured individual interviews were conducted with eleven purposely selected GPs and registrars
in Region Jämtland Härjedalen, Sweden, and subjected to qualitative content analysis.
Results:In the analysis of the interviews four categories were identified that described what made the physicians
suspect CRC and their practices.Careful listening—with awareness of the pitfalls:Attentive listening was described as
essential, but there was a risk of being misled by, for example, the patient’s own explanations.Tests can help—the
iFOBT can also complicate the diagnosis: All physicians used iFOBTs to various extents. In the absence of guidelines,
all found their own ways to interpret and act on the test results.To refer or not to refer—safety margins are
necessary:Uncertainty was described as a part of everyday work and was handled in different ways. Common vague
symptoms could be CRC and thus justified referral with safety margins.Growing more confident—but also more
humble:With increasing experience, the GPs described becoming more confident in their decisions but they were
also more cautious.
Conclusions:Listening carefully to the patient’s history was essential. The iFOBT was frequently used as support,
but there were considerable variations in the interpretation and handling of the results. The diagnostic process can
be described as navigating uncertain waters with safety margins, while striving to keep the patient’s best interests
in mind. The iFOBT may be useful as a diagnostic aid in primary care, but more research and evidence-based
guidelines are needed.