Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective

Objective
To explore how cancer could be diagnosed in a more timely way.

Design
Grounded theory analysis of primary care physicians’ free text survey responses to: ‘How do you think the speed of diagnosis of cancer in primary care could be improved?’. Secondary analysis of primary care physician interviews, survey responses, literature.

Setting
Primary care in 20 European Örenäs Research Group countries.

Subjects
Primary care physicians: 1352 survey respondents (2013-2016), 20 Spanish and 7 Swedish interviewees (2015–2019).

Main outcome measures
Conceptual explanation of how to improve timeliness of cancer diagnosis.

Results
Pluralistic task shifting is a grounded theory of a composite strategy. It includes task sharing – among nurses, physicians, nurse assistants, secretaries, and patients – and changing tasks with cancer screening when appropriate or cancer fast-tracks to accelerate cancer case finding. A pluralistic dialogue culture of comprehensive collaboration and task redistribution is required for effective pluralistic task shifting. Pluralistic task shifting relies on cognitive task shifting, which includes learning more about slow analytic reasoning and fast automatic thinking initiated by pattern recognition; and digital task shifting, which by use of eHealth and telemedicine bridges time and place and improves power symmetry between patients, caregivers, and clinicians. Financial task shifting that involves cost tracking followed by reallocation of funds is necessary for the restructuring and retraining required for successful pluralistic task shifting. A timely diagnosis reduces expensive investigations and waiting times. Also, late-stage cancers are costlier to treat than early-stage cancers. Timing is central to cancer diagnosis: not too early to avoid overdiagnosis, and never too late.

Conclusions
We present pluralistic task shifting as a conceptual summary of strategies needed to optimise the timeliness of cancer diagnosis.

Key points
Cancer diagnosis is under-researched in primary care, especially theoretically. Thus, inspired by classic grounded theory, we analysed and conceptualised the field:

Pluralistic task shifting is a conceptual explanation of how the timeliness of cancer diagnosis could be improved, with data derived mostly from primary care physicians.

This includes task sharing and changing tasks including screening and cancer fast-tracks to accelerate cancer case finding, and requires cognitive task shifting emphasising learning, and digital task shifting involving the use of eHealth and telemedicine.

Financial task shifting with cost tracking and reallocation of funds is eventually necessary for successful pluralistic task shifting to happen.