Theme 3.1 - The Pivot Study

The aim is to identify a population threshold, based on risk, for investigation of symptomatic cancer. Phase 1 identifies the most significant factors and Phase 2 aims to quantify them.

Phase 1

The aim is to identify which factors influence a patient's decision to undergo cancer investigation.


In-depth qualitative interviews will be conducted with patients who have undergone investigation for symptoms that may indicate cancer - the patients will be participants in The SYMPTOM Study in either Cambridgeshire or North Tees.

During the interviews patients will be asked what factors influenced their decision to undergo investigation and referral for cancer tests focusing on factors that encourage or discourage the decision to have a test.

Data will be analysed thematically using a framework approach.


The findings will contribute to the development of hypothetical scenarios used in the second phase of the PIVOT study and will also contribute to the overall programme aim of mapping and understanding cancer referral pathways.

Phase 2

The aim of this quantitative stage is to establish a patient centred risk level for colorectal, lung and pancreatic cancer below which the benefits of investigation are deemed to be outweighed by the negative factors.

Setting and participants

General Practice attendees over 40 years old across 12 General Practices in Bristol and Exeter will be asked to complete an electronic questionnaire.


Using the findings of Phase 1 along with clinical data a series of hypothetical scenarios are created for four different levels of risk of cancer (1%, 2%, 5% and 10%) for each of the three examplar cancers in the programme. For each scenario, participants will be given evidence based information on symptoms, the associated risk of cancer, details of the diagnostic test and likely outcomes. The scenarios will be developed by an expert panel made up of Discovery Programme team members.

The survey will be undertaken using a bespoke software system on hand held touch screen computers in GP waiting rooms. The software will enable scenarios to be generated randomly so that a balance of risk and cancers are considered by participants.

Participants will be presented with a scenario and asked if they would accept investigation. If the respondents answer positively they will be asked a 'willingness-to-pay' question to obtain information on the strength of preference for investigation. This is an established method used in health research to measure the value that people ascribe to services.

At least 1200 patients will complete the questionnaire allowing approximately 100 responses to each scenario.


This project answers a key question in cancer diagnostics: at what level does the population believe rapid investigation for possible cancer is warranted. This is valuable information in its own right and also serves as a major contribution to projects 3.2 and 3.3.

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10th February 2016

New Discovery Research publication

The SYMPTOM Study team's research into symptom appraisal for colorectal cancer has been published in BMJ Open. This is a unique piece of research which compares the appraisal and help seeking experiences of patients with colorectal cancer symptoms who go on to have cancer and those who turn out to have non-cancer conditions. The research did not identify any clear differences between the two groups but did identify important barriers to presentation around the ‘private nature’ of colorectal symptoms which will prove useful to policy makers and the design of awareness campaigns. To read more about the research paper see the results section here.

9th June 2015

Discovery conference slides available & new research publications

The Discovery Programme held its research conference at the Royal College of General Practitioners on June 2nd 2015. The team presented their research findings and outlined the impact of the programme to a wide range of patient groups, clinicians, policy makers, researchers and journalists. The PowerPoint slides used during the presentation have been uploaded to this website and can be viewed here.

There are also 2 new research papers to report. Chantal Balasooriya-Smeekens has published the literature review of her PhD in Psycho-Oncology, "The role of emotions in time to presentation for symptoms suggestive of cancer: a systematic review of quantitative studies". Abstract and publication details are here and further papers from Chantal's PhD will be published soon.

Nafees Din has published a new paper under the Discovery related research umbrella. The paper uses Discovery data drawn from the CAPER (theme 2) studies and considers "Age and Gender Variations in Cancer Diagnostic Intervals in 15 Cancers". Full publication details and abstract can be found here.