BACKGROUND How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). METHODS Participant observations of patient-provider encounters (n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. RESULTS One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. CONCLUSIONS Patients and GPs seem to be mutually dependent on each other and both patients' expertise and GPs' medical expertise need to be reconciled during the encounter. The four social processes reported in this study acknowledge the challenging task which both patients and primary healthcare face. Namely, negotiating sensations signaling possible cancer and further identifying and matching them with the best pathway for investigations corresponding as well to patients' needs as to standardized routines as CPPs.

中文翻译：

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在标准化癌症患者途径的背景下，在患者与GP之间进行身体感觉谈判-初级保健中的一项观察性研究。

背景技术很少探讨瑞典初级保健中患者与提供者之间的互动如何构成进一步保健的途径。由于标准化癌症患者通路已作为一种组织工具用于标准化诊断过程并增加获取的公平性，因此这在当今尤为重要。大多数症状表明患有严重疾病的患者，因为癌症最初是在初级保健中开始诊断的。此外，癌症症状是多种多样的，并且对全科医生（GP）有很高的要求。因此，我们旨在探讨在标准化癌症患者途径（CPPs）的背景下，如何在初级保健中遇到并建立身体感觉的陈述并使其合法化。方法参加者对患者与提供者的相遇的观察（n = 18，在瑞典北部一个县的主要医疗中心对18名独特的患者和13名GP进行了检查。参与者被连续采样，入选标准为：i）年龄在18岁或以上的患者，他们希望就可能表示癌症的症状/症状进行护理，或者对癌症感到担忧，瑞典语且无认知障碍，以及ii）与这些患者见面的全科医生在相遇中。扎根理论方法的建构主义方法指导了数据的收集，并被用作分析方法，并采用了定性研究的COREQ清单（赤道准则）。结果分析得出了一个概念模型，包括一个核心类别，即协商身体感觉以使获取合法化，以及四类：i）寻求护理的理由； ii）传播信誉；iii）寻求并给予认可，iv）平衡期望与需求。我们将这四个类别解释为患者和全科医生使用不同策略进行协商而交互构建的社会过程。这四个过程相结合，阐明了如何通过协商身体感受使访问合法化。结论患者和全科医生似乎相互依赖，并且在相遇期间需要调和患者的专业知识和全科医生的医学专业知识。这项研究报告的四个社会过程承认患者和初级保健人员都面临着艰巨的任务。即，通过协商传达可能的癌症信号，并进一步识别和匹配与患者病情相关的最佳调查途径