GPs’ involvement in diagnosing, treating, and referring patients with suspected or confirmed primary cutaneous melanoma: a qualitative study
Australia has the highest incidence of melanoma in the world and in Australia, melanoma can potentially be diagnosed and treated wholly within primary care. However, little is known about how GPs decide the extent of their involvement in melanoma management. To identify factors influencing GP’s decisions to diagnose, treat or refer patients with suspected melanoma, this study conducted interviews with 23 GPs working in general practice or skin cancer clinics in Australia. At the health system level, overlapping roles of GPs and specialists, and access to specialists was identified as an influencing factor. Practice level factors included opportunities for melanoma-related training, and having a GP with special interest in skin cancer. GP’s clinical interest, the clinical features and histopathology of the suspected melanoma, eligibility for lymph node biopsy, and patient preferences also influenced the GPs’ decision. There was considerable variation in GPs’ self-confidence; concerns over misdiagnosis and the option of referring patients at any stage appeared to affect GPs’ interest and confidence in melanoma management. The interview revealed how GPs involvement can extend beyond prevention, early detection and supportive care to include definitive melanoma management. Furthermore, the study highlights that more focus should be given to GPs’ involvement in melanoma management, particularly how GPs can be better supported to deliver optimal melanoma care for better health outcomes.