Pluralistic retasking. Re-thinking cancer diagnostics from a primary care physician perspective. A grounded theory study

Background Cancer diagnostics is heterogeneous depending on disease type, age, gender, socioeconomical and geographical contexts of patients and caregivers. Questions How could cancer be diagnosed in a more timely way from a primary care perspective? Methods Data from 1752 primary care physician (PCP) respondents in 20 countries and 20 Spanish and 7 Swedish PCP interviewees 2013-2019 analysed with classic grounded theory, especially free text responses to “How do you think the speed of diagnosis of cancer in primary care could be improved?”. Secondary analysis of interviews and literature. Outcomes We call PCP's ideas on improved cancer work-up pluralistic retasking: task shifting among physicians, nurses, assistants and secretaries involving task redistribution, task sharing, task collaboration, changing tasks – cancer fast tracks or cancer screening instead of cancer case finding when appropriate. Cognitive retasking involves both slow rational thinking in algorithms and fast intuitive thinking through gut feelings. Digital retasking bridges time and place by eHealth to reduce “elsewhereism” of experts and power symmetry issues between patient/caregiver. Shrinking gaps between and amongst patients and caregivers requires care restructuring and reallocation of funds. Care refinancing is thus necessary to improve diagnostic timeliness. Good cancer diagnostics needs good time management. Not too early (to avoid overdiagnosis) and never too late. Discussion Pluralistic retasking is a conceptual summary of multiple strategies needed to optimise the timeliness of cancer diagnostics. Take Home Message for Practice Can I do something differently to diagnose cancer in a more timely way?