Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol.

Designing a referral pathway for patients... | HRB Open Research dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); const cookieDomain = window.location.hostname; const tld = buildTLD(); function buildTLD() { const domainParts = cookieDomain.split('.'); while (domainParts.length > 2) { domainParts.shift(); } return domainParts.join('.'); } function deleteCookie(cookieName) { if (!cookieName) { return; } const cookiePath = (cookieName.startsWith('retraction_warning_') || cookieName.startsWith('version_warning_')) ? '/articles/' + cookieName : '/'; // Yes, these three slightly different ways to try and remove cookies are necessary document.cookie = cookieName + '=; path=' + cookiePath + '; domain=' + cookieDomain + '; expires=Thu, 01 Jan 1970 00:00:01 GMT;'; document.cookie = cookieName + '=; path=' + cookiePath + '; domain=.' + tld + '; expires=Thu, 01 Jan 1970 00:00:01 GMT;'; document.cookie = cookieName + '=; path=' + cookiePath + '; expires=Thu, 01 Jan 1970 00:00:01 GMT;'; } function deleteGroupCookies(group) { if (!group) { return; } const domainData = OneTrust.GetDomainData(), cookies = domainData.Groups.filter(cookieGroup => cookieGroup.OptanonGroupId === group)[0].Cookies; cookies.forEach(cookie => deleteCookie(cookie.Name)); } function OptanonWrapper() { const cookieConsentGroups = []; for (group of OneTrust.GetDomainData().Groups) { cookieConsentGroups.push(group.OptanonGroupId); } OneTrust.OnConsentChanged(function(e) { const cookieConsentActiveGroups = OnetrustActiveGroups.split(',').filter(activeGroup => activeGroup); cookieConsentGroups.forEach(group => { if (!cookieConsentActiveGroups.includes(group)) { deleteGroupCookies(group); }; }); }); } window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://hrbopenresearch.org/js/vendor/ckeditor/' window.reactTheme = 'HRB'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); Skip to content HRB Open Research file_upload Submit your research search clear search menu close clear Search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Data Guidelines Prepublication Checks Production Process Article Processing Charges Finding Article Reviewers About How it Works For Reviewers National Steering Group Policies Glossary FAQs Contact Blog My Account Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://hrbopenresearch.org/articles/8-127" }, "headline": "Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a...", "datePublished": "2025-11-24T13:12:38", "dateModified": "2025-11-24T13:12:38", "author": [ { "@type": "Person", "name": "Majid Khan" }, { "@type": "Person", "name": "Claire Reimer" }, { "@type": "Person", "name": "Conor Murphy" }, { "@type": "Person", "name": "Brona Mulligan" }, { "@type": "Person", "name": "James O'Mahony" }, { "@type": "Person", "name": "Mike O’Callaghan" }, { "@type": "Person", "name": "Georgia Black" }, { "@type": "Person", "name": "Carmel Geoghegan" }, { "@type": "Person", "name": "Kathleen Bennett" }, { "@type": "Person", "name": "Patrick Redmond" } ], "publisher": { "@type": "Organization", "name": "HRB Open Research", "logo": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 566, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 1200, "width": 127 }, "description": " Background Early cancer detection improves survival, but many cancers present initially with non-specific symptoms of cancer (NSSoC) such as weight loss, fatigue, or unexplained pain. These presentations are associated with longer diagnostic intervals and a later stage at diagnosis. Several countries have implemented diagnostic pathways for NSSoC, yet Ireland has no national model. Aim To explore the perspectives of patients, clinicians, managers, and policymakers to inform the design of an NSSoC referral pathway for Irish primary care. Methods Qualitative study using semi-structured interviews with general practitioners, hospital specialists, service managers, policymakers, advocacy representatives, and patients. Purposive sampling will achieve diversity by role, experience, and geography. Data will be collected via Microsoft Teams, transcribed verbatim, anonymised, and analysed using Framework Analysis structured by the Consolidated Framework for Implementation Research (CFIR). Findings will be mapped to the Engineering Better Care (EBC) framework to generate system-level design recommendations. Expected outcomes Identification of barriers, facilitators, and contextual determinants of an NSSoC pathway; practical, system-aware design principles for a patient-centred referral model suitable for the Irish context; and implementation considerations for policy and service planning. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://hrbopenresearch.org/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://hrbopenresearch.org/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://hrbopenresearch.org/articles/8-127/v1", "name": "Designing a referral pathway for patients with non-specific cancer..." } } ] } Home Browse Designing a referral pathway for patients with non-specific cancer... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Khan M, Reimer C, Murphy C et al. Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol. [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :127 ( https://doi.org/10.12688/hrbopenres.14283.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol. [version 1; peer review: 1 approved] Majid Khan https://orcid.org/0009-0006-8413-3872 1 , Claire Reimer 1 , Conor Murphy https://orcid.org/0009-0003-1166-0207 1 , [...] Brona Mulligan 1 , James O'Mahony 2 , Mike O’Callaghan https://orcid.org/0000-0002-8450-186X 3 , Georgia Black 4 , Carmel Geoghegan https://orcid.org/0000-0001-6670-5730 5 , Kathleen Bennett https://orcid.org/0000-0002-2861-7665 6 , Patrick Redmond 1 Majid Khan https://orcid.org/0009-0006-8413-3872 1 , Claire Reimer 1 , [...] Conor Murphy https://orcid.org/0009-0003-1166-0207 1 , Brona Mulligan 1 , James O'Mahony 2 , Mike O’Callaghan https://orcid.org/0000-0002-8450-186X 3 , Georgia Black 4 , Carmel Geoghegan https://orcid.org/0000-0001-6670-5730 5 , Kathleen Bennett https://orcid.org/0000-0002-2861-7665 6 , Patrick Redmond 1 PUBLISHED 24 Nov 2025 Author details Author details 1 Royal College of Surgeons in Ireland, Department of General Practice, Dublin, Leinster, Ireland 2 University College Dublin, Dublin, Leinster, Ireland 3 Irish College of General Practitioners, Dublin, Leinster, Ireland 4 Queen Mary University of London, London, England, UK 5 PRiCAN Patient and Public Involvement Lead, Royal College of Surgeons in Ireland Department of General Practice, Dublin, Leinster, Ireland 6 Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland Majid Khan Roles: Conceptualization, Methodology, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Claire Reimer Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing Conor Murphy Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Brona Mulligan Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing James O'Mahony Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Mike O’Callaghan Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Georgia Black Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Carmel Geoghegan Roles: Conceptualization, Writing – Review & Editing Kathleen Bennett Roles: Conceptualization, Supervision, Writing – Review & Editing Patrick Redmond Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the HRB Primary Care CTNI gateway. Abstract Background Early cancer detection improves survival, but many cancers present initially with non-specific symptoms of cancer (NSSoC) such as weight loss, fatigue, or unexplained pain. These presentations are associated with longer diagnostic intervals and a later stage at diagnosis. Several countries have implemented diagnostic pathways for NSSoC, yet Ireland has no national model. Aim To explore the perspectives of patients, clinicians, managers, and policymakers to inform the design of an NSSoC referral pathway for Irish primary care. Methods Qualitative study using semi-structured interviews with general practitioners, hospital specialists, service managers, policymakers, advocacy representatives, and patients. Purposive sampling will achieve diversity by role, experience, and geography. Data will be collected via Microsoft Teams, transcribed verbatim, anonymised, and analysed using Framework Analysis structured by the Consolidated Framework for Implementation Research (CFIR). Findings will be mapped to the Engineering Better Care (EBC) framework to generate system-level design recommendations. Expected outcomes Identification of barriers, facilitators, and contextual determinants of an NSSoC pathway; practical, system-aware design principles for a patient-centred referral model suitable for the Irish context; and implementation considerations for policy and service planning. READ ALL READ LESS Keywords Cancer, Primary care, Referral pathways, Early cancer detection, Stakeholders, Qualitative research Corresponding Author(s) Majid Khan ( [email protected] ) Close Corresponding author: Majid Khan Competing interests: No competing interests were disclosed. Grant information: This study is supported by the Breakthrough Cancer Research (BCR) Innovation Award 001_2024. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Khan M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Khan M, Reimer C, Murphy C et al. Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol. [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :127 ( https://doi.org/10.12688/hrbopenres.14283.1 ) First published: 24 Nov 2025, 8 :127 ( https://doi.org/10.12688/hrbopenres.14283.1 ) Latest published: 24 Nov 2025, 8 :127 ( https://doi.org/10.12688/hrbopenres.14283.1 ) Introduction Cancer remains a leading cause of mortality and morbidity globally and in Ireland 1 . More than 40,000 new malignancies are diagnosed annually in Ireland, and—if current trends persist—incidence is projected to double by 2045 2 . Although therapeutic advances continue to improve survival, the stage at diagnosis is the strongest prognostic determinant. For several common solid tumours, including colorectal and lung cancer, five-year survival exceeds 80% when diagnosed at stage I but falls below 20% at stage IV 2 , 3 . Accordingly, earlier diagnosis is prioritised within Irish and international cancer control strategies as a means of reducing mortality and limiting treatment-related morbidity 4 , 5 . Primary care as the diagnostic gateway In Ireland’s gatekeeping system, general practitioners (GPs) are usually the first point of contact for patients with new or concerning symptoms and control access to most specialist investigations and referrals. Primary care is the most effective setting for early cancer detection, given that most of the population interacts with GPs annually. In 2024, 79% of the Irish population visited a GP at least once, averaging 4.4 visits per person 6 . In contrast, fewer individuals consulted hospital specialists (36%), attended emergency departments (16%), or used out-of-hours GP services (9%) in 2023 7 . These patterns highlight the extensive scope of primary care and its vital function in early symptom recognition, investigation, and prompt diagnosis. Structured “fast-track” or “urgent suspected cancer” pathways for site-specific red-flag symptoms—such as a palpable breast mass —have improved diagnostic intervals and stage distribution at presentation 4 . However, these condition-specific pathways are not well suited to people whose cancers present initially with non-specific or low-risk, but not no-risk, symptoms, where the pre-test probability is modest and the likely tumour site is unclear. In the absence of a dedicated pathway, GPs with a high level of concern or clinical suspicion often rely on urgent care pathways, such as ‘Acute Medical Units’, or on community imaging direct access schemes, where they independently coordinate the diagnostic work-up and resultant findings. The diagnostic dilemma of non-specific symptoms of cancer (NSSoC) Non-specific symptoms of cancer—including unintentional weight loss, persistent fatigue, unexplained pain—carry low individual positive-predictive value for any single tumour site yet collectively account for approximately one in four cancer presentations 1 , 2 . Extensive primary-care cohort studies show that patients with NSSoC experience substantially more pre-referral consultations, longer primary-to-diagnosis intervals, and a two-fold higher likelihood of late-stage disease compared with patients who present with classical alarm features 3 , 4 . For GPs, decisions about escalation and investigation demand careful balancing of competing risks: avoiding missed cancers while minimising over-investigation and judiciously stewarding finite diagnostic capacity 4 . For patients, repeated consultations without diagnostic resolution can erode trust, exacerbate anxiety, and defer treatment initiation. Consequence of delayed diagnosis The clinical and system-level sequelae of late-stage diagnosis are well recognised. Advanced disease entails more intensive, toxic and costly therapies, poorer quality of life and markedly worse survival outcomes 8 , 9 . Health-system impacts include increased treatment costs, pressure on hospital capacity, and widening socioeconomic disparities, given that diagnostic delays disproportionately affect disadvantaged populations 8 , 9 . The psychological burden is also considerable; qualitative research describes frustration, self-doubt and stigma among individuals whose symptoms were initially attributed to benign causes 2 . These consequences strengthen the case for pathways that can safely accelerate diagnostic assessment for NSSoC. International policy responses Several European health systems have introduced dedicated models to address NSSoC. In Denmark, Diagnostic Centres provide rapid access to targeted laboratory panels, cross-sectional imaging and multidisciplinary review for patients with serious but non-specific symptoms; evaluations report short median times to diagnosis and high clinician acceptability 10 . In England, Rapid Diagnostic Centres integrate primary-care referral templates, standardised triage algorithms and one-stop investigative workups 11 . Sweden, Norway and the Netherlands have implemented comparable approaches, each adapted to local service configurations 12 . Although programme designs vary, common features include clear primary-care referral criteria based on symptom clusters or risk scores, direct access to cross-sectional imaging and key blood tests, streamlined multidisciplinary assessment, and active navigational support to guide patients through the diagnostic pathway. Early evidence suggests reductions in diagnostic intervals, improved patient experience and potential cost-effectiveness once downstream treatment savings are considered 13 . However, most evaluations are observational, and the extent to which outcomes depend on contextual factors—such as funding mechanisms, workforce availability and rurality—remains insufficiently understood. Knowledge and service gaps in Ireland Despite strategic commitments to earlier diagnosis, Ireland currently lacks a nationally coordinated referral pathway for NSSoC 5 . Access to diagnostics is uneven, with substantial inter-county variation in waiting times for CT, MRI and endoscopy 13 . GPs report uncertainty about thresholds for requesting imaging, inconsistent feedback on referrals and limited administrative support for tracking serial investigations 14 . Inconsistent management of incidental findings on cross-sectional imaging can lead to both overuse of resources and delayed diagnosis. In the absence of explicit referral criteria and protected diagnostic capacity, patients with NSSoC often navigate a fragmented system, oscillating between primary and secondary care before definitive investigation. This fragmentation risks prolonging diagnostic intervals, amplifying inequities—particularly for individuals in rural areas or with constrained resources—and increasing pressure on acute services. Addressing these shortcomings requires an approach that is context-appropriate and feasible within existing capacity constraints. Why a stakeholder-driven, systems approach is essential Introducing an NSSoC pathway constitutes a complex intervention spanning multiple professional groups, organisations and policy domains. The Medical Research Council’s guidance for complex interventions recommends preliminary qualitative work to map needs, barriers and enablers prior to pathway prototyping and evaluation 15 . In Ireland, stakeholder engagement is essential for clinical feasibility, operational sustainability and equity. Clinicians must trust the referral criteria and receive timely, bidirectional communication; managers and policymakers must balance additional diagnostic demand against finite imaging, pathology and workforce resources; and patients and carers can overcome access barriers linked to geography, socioeconomic position, language and health literacy, ensuring that implementation does not inadvertently widen disparities. A theory-informed approach can help organise this complexity. The Consolidated Framework for Implementation Research (CFIR) offers a comprehensive taxonomy to identify multilevel determinants related to the intervention, organisational context, individual actors and implementation processes 16 . The Engineering Better Care (EBC) framework complements CFIR by providing a structured systems perspective—people, systems, design, and risk—supporting the translation of qualitative insights into actionable pathway design principles, as illustrated in Figure 1 17 . Using CFIR to guide analysis and EBC to inform system-level recommendations enables a nuanced understanding of stakeholder perspectives and contextual constraints, while keeping the focus on practical design choices such as referral criteria, triage processes, access to diagnostics and patient navigation. Figure 1. Integrated systems approach for intervention design. (adapted from reference 17 ). Aim and objectives This study aims to explore the experiences and perspectives of healthcare professionals, patients and policymakers on the development of a referral pathway for patients presenting with non-specific symptoms of cancer in Irish primary care. The objectives are to identify perceived barriers and facilitators to diagnosing cancer in patients with NSSoC; to understand stakeholder views on the feasibility and acceptability of introducing an NSSoC referral pathway in Ireland; and to explore strategies to support integration of such a pathway into routine primary care practice. Methods Study design We will conduct a qualitative study using semi-structured interviews to explore determinants, feasibility and design considerations for an NSSoC referral pathway in Irish primary care. The study will be reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ, 32 items) 18 . The CFIR will guide data analysis, and the EBC framework will inform topic guide development and the translation of findings into system-level design recommendations 16 . Theoretical framework CFIR provides a structured taxonomy of intervention characteristics, inner and outer settings, individual characteristics, and implementation processes. We will use CFIR deductively to scaffold coding and matrix development while allowing inductive subthemes to emerge within domains. The EBC framework (people, systems, design, risk) will be applied at the interpretation stage to convert implementation determinants into practical pathway features (especially referral criteria, triage procedures, diagnostic access, communication pathways, and equity safeguards) 17 . Framework Analysis will be the primary analytic approach, as it is well-suited to applied, policy-relevant questions and supports comparative analysis across stakeholder groups 16 . Data collection will take place online to facilitate participation across Ireland, primarily via Microsoft Teams using institutional accounts. Telephone interviews will be offered for participants with limited digital access. The study will be coordinated by the Department of General Practice, RCSI University of Medicine and Health Sciences. Participants and eligibility We will include adults (≥18 years) from three stakeholder groups. Patients will be eligible if they presented with NSSoC within the previous five years and underwent investigation with or without a cancer diagnosis. Individuals who lack the capacity to consent, who would require professional interpretation beyond the study team's capacity, or who are in acute distress at the time of approach will be excluded. Clinicians will include general practitioners and relevant hospital-based professionals involved in diagnosing cancer in patients with non-specific presentations (e.g., general medicine, oncology, radiology). Clinicians must be practising in Ireland during the study period. Managers, policymakers and advocacy stakeholders will include service managers, representatives of the National Cancer Control Programme (NCCP) and the Irish College of General Practitioners (ICGP), and representatives of patient advocacy organisations with roles relevant to cancer referral policy or service design. Sampling and sample size We aim to recruit approximately 25–30 participants, distributed as follows: 8–10 GPs, 6–8 hospital clinicians, 5–6 managers, policymakers, or advocacy stakeholders, and 6–8 patients. This sampling strategy is flexible and designed to ensure a comprehensive representation of diverse experiences and perspectives, rather than adhering strictly to a predefined numerical threshold for data saturation 19 – 21 . Recruitment and consent Potential participants will be identified through professional networks (ICGP, NCCP), the Irish Cancer Society and affiliated advocacy groups, academic and service contacts, and announcements at relevant meetings. Interested individuals will receive an invitation pack comprising a study invitation letter, Participant Information Leaflet (PIL), and consent form. Non-responders will receive one reminder approximately two weeks later. Reasons for non-participation, where offered, will be recorded to appraise recruitment barriers. Written informed consent will be obtained electronically before data collection. Where patient participants request support, a caregiver may be present; this will be documented, and the caregiver will not contribute unless explicitly invited by the participant. Contingency Plan: We have devised a contingency plan in case we face difficulties with recruitment. 1. In addition to purposive sampling, we will use snowball sampling by asking interviewees to recommend other suitable and willing participants for the study. 2. Expanding recruitment across additional organisations or professional networks if initial numbers prove insufficient. 3. Broadening the scope of eligible participants within each stakeholder group, while maintaining alignment with NSSoC. 4. Extending the recruitment period, if necessary, to ensure adequate response time from participants. 5. Employing multiple dissemination strategies, such as professional newsletters and targeted social media campaigns. 6. Increasing the compensation for participants from 25 Euros. Suppose recruitment remains below expectations despite these measures. In that case, we will transparently report the limitations in the study findings and adjust the analytical approach to ensure that the diversity and depth of available narratives are accurately represented. Data collection Interviews will be one-to-one, audio-recorded with permission, and are expected to last 30–60 minutes. Topic guides tailored for patients, clinicians, and policymakers will ensure coverage of CFIR domains while incorporating EBC perspectives. Guides will be refined with input from the Patient and Public Involvement (PPI) lead to optimise clarity and sensitivity. We will pilot test the guides with one participant from each stakeholder group and make minor amendments if needed. Field notes and brief analytic memos will be completed after each interview or group to capture contextual details (e.g., interruptions, affect, rapport) and early interpretive insights. Participants will be offered the option to review their transcripts for accuracy. Any requested corrections will be logged, and the original and revised versions will be retained in the audit trail. Research characteristics and reflexivity Trained researchers from the RCSI Department of General Practice will conduct interviews. The team includes clinicians and health services researchers with expertise in qualitative methods. Prior relationships with participants are not anticipated; any such relationships will be declared and reflected upon. We will maintain reflexive memos documenting researchers’ assumptions, disciplinary perspectives, and potential influences on data generation and interpretation. The COREQ checklist will report interviewer roles, training and positionality 18 . Data management, security and confidentiality Audio files will be uploaded immediately to encrypted, access-restricted institutional servers and deleted from local devices. Transcription will be undertaken by an approved provider under a confidentiality agreement and verified by the research team. Transcripts will be anonymised by removing names and other identifiers. Only the study team will have access to identifiable data. In line with institutional policy, data will be retained securely for up to 10 years and then destroyed. Processing of personal data will comply with the General Data Protection Regulation (GDPR) and Irish legislation 22 , 23 . The data controller will be RCSI. Participants may withdraw up to two weeks after transcript return; at that point, their data will be removed where feasible. Analysis We will undertake Framework Analysis using NVivo (version 10 or higher). Analysis will proceed through familiarisation, development of an initial analytical framework informed by CFIR domains, indexing (coding) of transcripts, charting into a case-by-theme matrix, and mapping/interpretation. Within each CFIR domain, we will generate inductive subthemes to capture participant-driven insights. At least two researchers will undertake coding. An initial subset of transcripts (approximately 20–30%) will be double-coded to calibrate the framework, followed by periodic cross-checks. Differences will be resolved by discussion, with escalation to a third team member if needed. An audit trail will document framework iterations, coding decisions and reflexive considerations. Following analysis, we will map priority determinants and candidate strategies to the EBC framework to derive actionable system-level recommendations for pathway design, including equity considerations (e.g., rural access, deprivation), capacity (e.g., imaging slots, laboratory turnaround), and governance (e.g., feedback loops between primary and secondary care). Patient and public involvement The PPI lead (CG) is a co-author and contributed to the study conception and the wording of participant-facing materials and topic guides. PPI input will inform recruitment strategies (including accessibility considerations), interpretation of findings (particularly around acceptability and equity), and dissemination products (plain-language summaries and policy briefs). We will report PPI activities and their impact within the manuscript. Discussion This protocol describes a qualitative study to explore the perspectives of general practitioners, hospital specialists, service managers, policymakers, advocacy representatives, and patients on developing a referral pathway for NSSoC in Irish primary care. The study will generate a detailed understanding of barriers and enablers to timely diagnosis, contextual constraints within the Irish health system, and design considerations for a pathway that is both feasible, acceptable, and implementable. A distinctive contribution is the integration of the CFIR framework and the interpretation of findings through the EBC framework, allowing stakeholder insights to shape system-level, actionable design principles. Comparison with existing literature International evidence demonstrates that patients presenting with NSSoC frequently experience diagnostic delay, repeated consultations, and late-stage cancer diagnosis 24 . Dedicated diagnostic pathways, such as Denmark’s Diagnostic Centres and England’s non-specific symptoms referral pathways, have reported shorter time to diagnosis, improved patient satisfaction, and high clinician acceptability 10 , 25 . However, these evaluations have been largely observational, and relatively little is known about how differences in health system structure, financing, and workforce capacity influence performance. Ireland presents a distinctive context. The absence of a nationally coordinated NSSoC pathway, coupled with variable access to diagnostic imaging and endoscopy, creates structural inequities in the timeliness of diagnosis 14 . General practitioners act as gatekeepers to specialist care but report uncertainty about escalation thresholds and limited feedback on referrals. This study will address a vital evidence gap by documenting Irish-specific barriers and facilitators and examining how lessons from international models can be adapted to a mixed public–private health system with marked geographical variation in access. Strengths and contributions This will be the first Irish multi-stakeholder study to examine NSSoC referral challenges spanning patients, carers, primary care and secondary care professionals, and system leaders. CFIR enables systematic identification of multilevel determinants, while mapping to the EBC framework supports translation into practical design features (e.g., referral criteria, triage processes, minimum diagnostic bundles, communication loops, navigation support and equity safeguards). The emphasis on systems thinking is particularly relevant given that introducing a new referral pathway will inevitably interact with existing diagnostic capacity, workforce distribution, and policy priorities. By capturing both professional and patient experiences, the study will also shed light on issues of equity, including whether rural populations, socioeconomically disadvantaged groups, or those with limited health literacy face distinct barriers to timely diagnosis. These insights are essential if the pathway is to avoid inadvertently exacerbating disparities in cancer outcomes. Limitations As with all qualitative studies, findings will be shaped by the perspectives of participants who agree to take part, and self-selection bias may lead to over-representation of stakeholders with a particular interest in service improvement. Despite purposive sampling, some groups—such as patients who disengage from the healthcare system, or clinicians working in the most resource-constrained settings—may be under-represented. The use of online interviews may limit participation among individuals with low digital literacy or poor internet access. Including patients up to 5 years post-presentation introduces potential recall bias. Excluding participants who require professional interpretation may limit transferability to non-English-speaking populations. Participant compensation may introduce minimal participation bias, although its value and timing are unlikely to affect interview content. Researcher positionality (a GP-led team) will be addressed through reflexive practice, but may shape data generation and interpretation. Finally, the study explores anticipated feasibility and acceptability rather than observing pathway use; policy and capacity contexts may evolve during the study period. Implications for practice and policy Findings will inform the co-design of a national NSSoC referral pathway by articulating (i) candidate referral criteria and decision-support content for e-referral, (ii) triage models (e.g., centralised versus regional), (iii) a minimum diagnostic bundle (key bloods and cross-sectional imaging access), (iv) bidirectional communication standards between primary and secondary care, and (v) equity safeguards (navigation support; monitoring by HSE region and deprivation quintile). At the policy level, the study will identify enabling conditions for implementation, including protected diagnostic capacity, workforce training, governance arrangements (e.g., NCCP oversight), data flows and a core indicator set (e.g., time to first test, conversion and detection rates, stage at diagnosis, patient-reported experience). Future research This qualitative phase will inform a prototype pathway and logic model for piloting in real-world settings. Subsequent studies will employ mixed-methods and implementation science designs to assess effectiveness and economic evaluation. Evaluation will include fidelity, feasibility and acceptability measures, alongside hard outcomes (diagnostic interval, stage at diagnosis) and process metrics (triage timelines, imaging turnaround). Comparative work with international models will help understand context–mechanism–outcome relationships and refine transferability. Conclusion This study addresses a critical gap in Irish cancer services by exploring how an NSSoC referral pathway might be designed and implemented within primary care. By integrating diverse stakeholder perspectives and applying theory-informed frameworks, the research aims to generate actionable, system-aware recommendations that support earlier diagnosis, more efficient resource use, and equitable access to timely cancer care. Ethics and consent Ethics Approval is being sought from the Irish College of General Practitioners Ethics Review Committee (ICGP_REC_2025_ 3182) Written informed consent will be obtained electronically before data collection. Where patient participants request support, a caregiver may be present; this will be documented, and the caregiver will not contribute unless explicitly invited by the participant. Pre-registration This protocol will be published on HRB Open, and appendices will be made available via the Open Science Framework. Data availability No data associated with this article. Extended data OSF: Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol https://doi.org/10.17605/OSF.IO/TPZJX 26 (Invitation letter, participant information leaflet, participant consent form, interview guides and COREQ guidelines checklist are available via the Open Science Framework). Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Reporting guideline COREQ is a 32-item checklist used to assess the quality of qualitative research 18 . Acknowledgements The authors gratefully acknowledge Sophie Bahadursingh for her assistance with the early draft, Dr Nicholas Clarke for co-helping with the funding application, Dr Una Kennedy for co-supporting the funding application, and the pledge to help disseminate study information to aid in interview recruitment. Faculty Opinions recommended References 1. Sung H, Ferlay J, Siegel RL, et al. : Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71 (3): 209–249. PubMed Abstract | Publisher Full Text 2. National Cancer Registry Ireland: Cancer in Ireland 1994–2022: Annual statistical report of the National Cancer Registry (2024). Cork: National Cancer Registry Ireland, 2024; [cited 2025 Jul 30]. Reference Source 3. National Cancer Registry Ireland: Statistics. Cork: National Cancer Registry Ireland, 2024; [cited 2025 Jul 30]. Reference Source 4. Rubin G, Berendsen A, Crawford SM, et al. : The expanding role of primary care in cancer control. Lancet Oncol. 2015; 16 (12): 1231–72. PubMed Abstract | Publisher Full Text 5. Department of Health (Ireland): National Cancer Strategy 2017–2026. Dublin: Government of Ireland. [cited 2025 Jul 30]. Reference Source 6. Department of Health (Ireland): Healthy Ireland Survey 2024. Dublin: Government of Ireland. [cited 2025 Oct 7]. Reference Source 7. Department of Health (Ireland): Healthy Ireland Survey Summary Report 2023. Dublin: Government of Ireland. [cited 2025 Oct 7]. Reference Source 8. McGarvey N, Gitlin M, Fadli E, et al. : Increased healthcare costs by later stage cancer diagnosis. BMC Health Serv Res. 2022; 22 (1): 1155. PubMed Abstract | Publisher Full Text | Free Full Text 9. Whitaker K: Earlier diagnosis: the importance of cancer symptoms. Lancet Oncol. 2020; 21 (1): 6–8. PubMed Abstract | Publisher Full Text 10. Damhus CS, Brodersen JB, Nielsen GL: Diagnostic flow for all patients referred with Non-Specific Symptoms of Cancer to a diagnostic centre in Denmark: a descriptive study. Eur J Gen Pract. 2024; 30 (1): 2296108. PubMed Abstract | Publisher Full Text | Free Full Text 11. White C, Robinson S, Macleod U, et al. : GP referral to Rapid Diagnostic Centres for non-specific cancer symptoms: a qualitative study. BJGP Open. 2025; 9 (3): BJGPO.2024.0179. PubMed Abstract | Publisher Full Text 12. Stenman E, Palmér K, Rydén S, et al. : Diagnostic spectrum and time intervals in Sweden’s first Diagnostic Center for patients with Nonspecific Symptoms of Cancer. Acta Oncol. 2019; 58 (3): 296–305. PubMed Abstract | Publisher Full Text 13. O’Riordan M, Doran G, Collins C: Access to diagnostics in primary care and the impact on a primary care led health service. Ir Med J. 2015; 108 (2): 53–5. PubMed Abstract 14. O’Callaghan ME, Fawsitt R, Gao J, et al. : Irish General Practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study. Ir J Med Sci. 2024; 193 (1): 425–434. PubMed Abstract | Publisher Full Text | Free Full Text 15. Skivington K, Matthews L, Simpson SA, et al. : A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021; 374 : n2061. PubMed Abstract | Publisher Full Text | Free Full Text 16. Damschroder LJ, Aron DC, Keith RE, et al. : Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009; 4 (1): 50. PubMed Abstract | Publisher Full Text | Free Full Text 17. Clarkson J, Bogle D, Dean J, et al. : Engineering better care: a systems approach to health and care design and continuous improvement. 2017; [cited 2025 Aug 14]. Publisher Full Text 18. Tong A, Sainsbury P, Craig J: Consolidated criteria for Reporting Qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19 (6): 349–57. PubMed Abstract | Publisher Full Text 19. Sandelowski M: Sample size in qualitative research. Res Nurs Health. 1995; 18 (2): 179–83. PubMed Abstract | Publisher Full Text 20. Saunders MNK, Townsend K: Reporting and justifying the number of interview participants in organization and workplace research. Br J Manag. 2016; 27 (4): 836–852. Publisher Full Text 21. Vasileiou K, Barnett J, Thorpe S, et al. : Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC Med Res Methodol. 2018; 18 (1): 148. PubMed Abstract | Publisher Full Text | Free Full Text 22. Data Protection Commission: Data Protection Legislation. Dublin: Data Protection Commission. [cited 2025 Oct 7]. Reference Source 23. European Union: Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) (Text with EEA relevance). Brussels: European Union, May 4, 2016; [cited 2025 Oct 7]. Reference Source 24. Black GB, Khalid AF, Lyratzopoulos G, et al. : Exploring the policy implementation of a holistic approach to cancer investigation in non-specific symptom pathways in England: an ethnographic study. J Health Serv Res Policy. 2025; 30 (1): 21–30. PubMed Abstract | Publisher Full Text | Free Full Text 25. Friedemann Smith C, Moreland JA, Virdee PS, et al. : Patient characteristics, serious disease diagnoses, and incidental findings in individuals with non-specific symptoms referred to the Suspected CANcer (SCAN) Pathway: a prospective cohort study in England. Lancet Prim Care. 2025; 100019. Publisher Full Text 26. Khan M: Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol. 2025; [cited 2025 Oct 28]. https://osf.io/tpzjx/ Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 24 Nov 2025 ADD YOUR COMMENT Comment Author details Author details 1 Royal College of Surgeons in Ireland, Department of General Practice, Dublin, Leinster, Ireland 2 University College Dublin, Dublin, Leinster, Ireland 3 Irish College of General Practitioners, Dublin, Leinster, Ireland 4 Queen Mary University of London, London, England, UK 5 PRiCAN Patient and Public Involvement Lead, Royal College of Surgeons in Ireland Department of General Practice, Dublin, Leinster, Ireland 6 Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland Majid Khan Roles: Conceptualization, Methodology, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Claire Reimer Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing Conor Murphy Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Brona Mulligan Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing James O'Mahony Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Mike O’Callaghan Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Georgia Black Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Carmel Geoghegan Roles: Conceptualization, Writing – Review & Editing Kathleen Bennett Roles: Conceptualization, Supervision, Writing – Review & Editing Patrick Redmond Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This study is supported by the Breakthrough Cancer Research (BCR) Innovation Award 001_2024. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 24 Nov 2025, 8:127 https://doi.org/10.12688/hrbopenres.14283.1 Copyright © 2025 Khan M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Khan M, Reimer C, Murphy C et al. Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol. [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :127 ( https://doi.org/10.12688/hrbopenres.14283.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 24 Nov 2025 Views 0 Cite How to cite this report: Wang J. Reviewer Report For: Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol. [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :127 ( https://doi.org/10.21956/hrbopenres.15714.r52217 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-127/v1#referee-response-52217 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Jan 2026 Jiayue Wang , Changhai Hospital, Shanghai, Shanghai, China Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15714.r52217 This manuscript presents a well-conceived study protocol for a qualitative investigation. The research aims to address a significant evidence-practice gap in Irish cancer care by exploring the design of a national referral pathway for patients presenting with NSSoC. While the ... Continue reading READ ALL This manuscript presents a well-conceived study protocol for a qualitative investigation. The research aims to address a significant evidence-practice gap in Irish cancer care by exploring the design of a national referral pathway for patients presenting with NSSoC. While the topic is timely and the methodology broadly appropriate, I have some comments for further improvement: 1. Insufficient Detail on Researcher Reflexivity and Positionality While the protocol notes the interviewer's background, it lacks a structured plan to address critical aspects of researcher positionality and its potential influence on data collection. Specifically, it omits consideration of researcher gender and a clear statement on what information about this research will be disclosed to participants. These factors may significantly impact the interview. To address this, the authors should add the gender and relevant professional backgrounds of the interviewers, a brief analysis of how these attributes might influence the research, and an explicit statement of what will be disclosed to participants (e.g., role, affiliation, study purpose) to the reflexivity section. 2. Lack of Specific Plan for Documenting Sample Characteristics The protocol does not state what key demographic and characteristic data will be systematically collected from participants to describe the final sample. Without planned details such as patient age, symptom history, GP practice location/size, or specialist discipline, readers cannot assess the sample's composition or the potential transferability of findings. To address this, the authors must integrate a clear plan for collecting sample data. It is recommended to include a table within the methods outlining the planned variables for each stakeholder group (e.g., age, gender, professional/clinical context) and explain that this data will be gathered via a brief demographic form. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Gastroenterology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Wang J. Reviewer Report For: Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol. [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :127 ( https://doi.org/10.21956/hrbopenres.15714.r52217 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-127/v1#referee-response-52217 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 24 Nov 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 24 Nov 25 read Jiayue Wang , Changhai Hospital, Shanghai, China Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Wang J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Jan 2026 | for Version 1 Jiayue Wang , Changhai Hospital, Shanghai, Shanghai, China 0 Views copyright © 2026 Wang J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript presents a well-conceived study protocol for a qualitative investigation. The research aims to address a significant evidence-practice gap in Irish cancer care by exploring the design of a national referral pathway for patients presenting with NSSoC. While the topic is timely and the methodology broadly appropriate, I have some comments for further improvement: 1. Insufficient Detail on Researcher Reflexivity and Positionality While the protocol notes the interviewer's background, it lacks a structured plan to address critical aspects of researcher positionality and its potential influence on data collection. Specifically, it omits consideration of researcher gender and a clear statement on what information about this research will be disclosed to participants. These factors may significantly impact the interview. To address this, the authors should add the gender and relevant professional backgrounds of the interviewers, a brief analysis of how these attributes might influence the research, and an explicit statement of what will be disclosed to participants (e.g., role, affiliation, study purpose) to the reflexivity section. 2. Lack of Specific Plan for Documenting Sample Characteristics The protocol does not state what key demographic and characteristic data will be systematically collected from participants to describe the final sample. Without planned details such as patient age, symptom history, GP practice location/size, or specialist discipline, readers cannot assess the sample's composition or the potential transferability of findings. To address this, the authors must integrate a clear plan for collecting sample data. It is recommended to include a table within the methods outlining the planned variables for each stakeholder group (e.g., age, gender, professional/clinical context) and explain that this data will be gathered via a brief demographic form. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Gastroenterology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Wang J. Peer Review Report For: Designing a referral pathway for patients with non-specific cancer symptoms in Irish primary care: a qualitative study protocol. [version 1; peer review: 1 approved] . HRB Open Res 2025, 8 :127 ( https://doi.org/10.21956/hrbopenres.15714.r52217) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-127/v1#referee-response-52217 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with HRB Open Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Designing a referral pathway for patients...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://hrbopenresearch.org/articles/8-127/v1" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://hrbopenresearch.org/articles/8-127/v1&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://hrbopenresearch.org/articles/8-127/v1" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Khan M et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://hrbopenresearch.org/articles/8-127/v1/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://hrbopenresearch.org/articles/8-127", templates : { twitter : "Designing a referral pathway for patients with non-specific cancer.... Khan M et al., published by " + "@HRBOpenRes" + ", https://hrbopenresearch.org/articles/8-127/v1" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/14283/15714") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "15714"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "51840": 0, "51841": 0, "51842": 0, "51843": 0, "51844": 0, "51845": 0, "51846": 0, "52383": 0, "52384": 0, "52385": 0, "52386": 0, "52387": 0, "52388": 0, "52389": 0, "52390": 0, "53030": 0, "52391": 0, "53031": 0, "52392": 0, "53032": 0, "53033": 0, "53034": 0, "53035": 0, "53036": 0, "53037": 0, "53038": 0, "53039": 0, "52027": 0, "52028": 0, "52029": 0, "52030": 0, "52031": 0, "52032": 0, "52033": 0, "52034": 0, "52035": 0, "52036": 0, "52715": 0, "52716": 0, "52717": 0, "52718": 0, "52719": 0, "52720": 0, "52721": 0, "52722": 0, "52723": 0, "52724": 0, "52725": 0, "52213": 0, "52726": 0, "52214": 0, "52215": 0, "52216": 0, "52217": 16, "52218": 0, "52219": 0, "52220": 0, "51837": 0, "52221": 0, "51838": 0, "52222": 0, "51839": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "0d8193f8-c237-438b-8a17-a727cdd72f79"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); Are you a HRB-funded researcher? Submission to HRB Open Research is open to all HRB grantholders or people working on a HRB-funded/co-funded grant on or since 1 January 2017. Sign up for information about developments, publishing and publications from HRB Open Research. First Name * You must provide your first name Last Name * You must provide your last name Email * You must provide a valid email address Institution You must provide an institution. Submit Thank you! We'll keep you updated on any major new updates to HRB Open Research HRB Open Research Browse How to Publish About Contact RSS Cookie Notice Privacy Notice Legal Submit Your Research © F1000 Research Limited and its licensors ISSN 2515-4826 | Legal background var F1000platform = new F1000.Platform({ name: "hrb", displayName: "HRB Open Research", hostName: "hrbopenresearch.org", id: "5", editorialEmail: "[email protected]", infoEmail: "[email protected]" }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); }); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9fec36e5abe64807',t:'MTc3OTI4OTI2Mg=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();