Pre-disclosure of cancer in general practice: A key stage in patient management

Background. The diagnosis of cancer is communicated to a patient during a consultation designed to deliver the news, which incorporates a structured timeline and a multidisciplinary approach. However, prior to the start of oncological care, the patient will need to consult their general practitioner (GP). The GP is involved in the early stages of the diagnostic pathway, carrying out screening, identifying symptoms and coordinating the pathway. This consultation prior to the diagnosis, known as the ‘pre-disclosure consultation, has been little studied. Objec-tive: To determine the content of the ‘pre-disclosure’ consultation carried out by GPs in practice. Method. A retrospective quantitative study was conducted using a questionnaire among GPs who referred pa-tients who had a cancer disclosure consultation between 1 October and 31 December 2017 in Toulouse, France. The online questionnaire comprised 34 closed-ended questions and one open-ended question. Data analysis was descriptive. Results. Of the 174 patient records selected, corresponding to 174 different GPs, 81 GPs responded. Fifty-four had carried out a ‘pre-disclosure’ consultation (89% lasting more than 15 minutes, 26% more than 30 minutes). Half mentioned supportive care; almost all considered it helpful for coming to terms with the illness, and 85 per cent limited the information in order to deliver the news in stages. Conversely, 27 of the GPs had not given a ‘pre-disclosure’, half of whom would have liked to have done so Conclusion. The ‘pre-disclosure’ is carried out informally. GPs take the time to organise this consultation and tailor it to the patient. However, a lack of information and the isolation of GPs complicate the ‘pre-disclosure’. Integrating it into the disclosure process could improve the coordination of care. Structuring the ‘pre-disclosure’ using appropriate tools and providing better support for GPs is necessary to support patients.