The Potential Role of Point-of-Care Tests in Improving Cancer Diagnosis in Primary Care

Most patients with possible cancer symptoms first present in primary care. The availability of reliable, rapid cancer detection tests in general practice has the potential to expedite diagnosis and support the timely management of patients. This thesis aimed to explore the possible role of point-of-care tests (POCTs) for cancer in primary care by mapping the evidence on available tests and assessing their acceptability and feasibility from clinician and public perspectives. Study 1 was a systematic scoping review to identify commercially available cancer POCTs for use in primary care, and assess the evidence based on an evaluation framework. The review, which included 36 unique reports, identified 22 POCTs for cancers such as bladder, gastrointestinal/colorectal, prostate, oral, and lung. Most POCTs were only evaluated for analytical performance or clinical performance, indicating a gap in knowledge regarding their acceptability and feasibility. Study 2 was a theoretically informed qualitative interview study with 32 general practitioners (GPs) to explore their views on the acceptability and feasibility of cancer POCTs in primary care. GPs found POCTs acceptable if they were accurate, well-designed, and supported by robust evidence and resources. Study 3 was a theoretically informed mixed-methods study with 2303 adults, assessing the public acceptability of cancer POCTs in the UK. The study found POCTs were highly acceptable due to their quick turnaround time for results. However, participants emphasised the importance of test accuracy, clear communication regarding test limitations, and the need for genuine choice in the decision to undergo testing. Overall, while there is increasing innovation in the development of cancer POCTs, current technologies have not been adequately evaluated for their use in primary care. Implementation of POCTs would require robust evaluations, system-level changes, and careful consideration of issues important to GPs and patients by test developers and policymakers.