Clinical decision making and risk appraisal using electronic risk assessment tools (eRATs) for cancer diagnosis: A qualitative study of GP experiences.

Background: Electronic Risk Assessment Tools (eRATs) are intended to improve early primary care cancer diagnosis. eRATs which interrupt a consultation to suggest a possibility of a cancer diagnosis, could impact clinical appraisal and the experience of the consultation. This study explores this issue using data collected within the context of the ERICA trial.

Aim: To explore experiences of General Practitioners (GPs) who used the ERICA eRATs, and how the tool impacted their perception of risk and diagnostic thinking, and communication of this to patients.

Design & Setting: Qualitative interviews with GPs from English General Practices undertaking the ERICA trial.

Method: Participants were purposefully sampled from practices participating in the intervention arm of the ERICA trial. 18 GPs undertook semi-structured interviews via MS Teams. Thematic Analysis was used to explore their perspectives the impact of eRATs on consultations, diagnostic thinking related to cancer and other conditions, and how this information is communicated to patients.

Results: Three themes were developed: 1) eRATs were perceived as "Additional Armour", offering a layer of protection against missing a cancer diagnosis, the defence coming at a cost of anxiety and complexity of consultation; 2) eRATs were seen as another actor in the consultation, separate from clinician and patient, and challenging GP autonomy; and 3) GPs were conflicted about whether the numerical eRAT outputs were helpful when communicating with patients.

Conclusion: eRATs are appreciated as a defence against missing a cancer diagnosis. This defence comes at a cost and challenges GP's freedom in communication and decision making.