Article Text

Download PDFPDF
Peers without fears? Barriers to effective communication among primary care physicians and oncologists about diagnostic delays in cancer
  1. Allison Lipitz-Snyderman1,
  2. Minal Kale2,
  3. Laura Robbins3,
  4. David Pfister4,
  5. Elizabeth Fortier1,
  6. Valerie Pocus1,
  7. Susan Chimonas1,
  8. Saul N Weingart5
  1. 1 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2 Icahn School of Medicine at Mount Sinai, Department of General Internal Medicine, New York, New York, USA
  3. 3 Hospital for Special Surgery, Research Division, New York, New York, USA
  4. 4 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  5. 5 Tufts Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Allison Lipitz-Snyderman, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 485 Lexington Ave., New York, NY 10017, USA; snyderma{at}


Objective Relatively little attention has been devoted to the role of communication between physicians as a mechanism for individual and organisational learning about diagnostic delays. This study’s objective was to elicit physicians’ perceptions about and experiences with communication among physicians regarding diagnostic delays in cancer.

Design, setting, participants Qualitative analysis based on seven focus groups. Fifty-one physicians affiliated with three New York-based academic medical centres participated, with six to nine subjects per group. We used content analysis to identify commonalities among primary care physicians and specialists (ie, medical and surgical oncologists).

Primary outcome measure Perceptions and experiences with physician-to-physician communication about delays in cancer diagnosis.

Results Our analysis identified five major themes: openness to communication, benefits of communication, fears about giving and receiving feedback, infrastructure barriers to communication and overcoming barriers to communication. Subjects valued communication about cancer diagnostic delays, but they had many concerns and fears about providing and receiving feedback in practice. Subjects expressed reluctance to communicate if there was insufficient information to attribute responsibility, if it would have no direct benefit or if it would jeopardise their existing relationships. They supported sensitive approaches to conveying information, as they feared eliciting or being subject to feelings of incompetence or shame. Subjects also cited organisational barriers. They offered suggestions that might facilitate communication about delays.

Conclusions Addressing the barriers to communication among physicians about diagnostic delays is needed to promote a culture of learning across specialties and institutions. Supporting open and honest discussions about diagnostic delays may help build safer health systems.

  • Diagnostic errors
  • Communication
  • Qualitative research
  • Healthcare quality improvement

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Conception or design: ALS. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: ALS. Critical revision of the manuscript for important intellectual content: all authors. Final approval of manuscript: all authors. Obtained funding: ALS. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Ethics approval Institutional Review Boards at Memorial Sloan Kettering Cancer Center, the Icahn School of Medicine at Mount Sinai, and Weill Cornell Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Summary data are available upon request.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.