Table 3 Comments regarding barriers to recording cancer stage at diagnosis in cancer registrations (coders) and MDM software (clinicians)

 - Domain: Environmental context and resources

  ‘When MDM notes, referral letters or other clinical notes are available, the stage is often not recorded’—public, major city and inner regional clinical coder, > 5 years’ experience.

  ‘As a clinical coder, the biggest barrier to recording stage is a lack of documentation to support this. I can only record the stage if it is documented by a clinician’ —public, major city, > 5 years’ experience.

  ‘Often [stage] not recorded anywhere. MDM notes may be blank at the section where it is usually recorded, and pathology reports often won’t have it documented either’—public and private, major city hospitals, 2–5 years’ experience.

 - Domain: knowledge

  ‘Our system is very clunky to record cancers. We have about a 60-page document which tells us how to report cancers. I think it’s very confusing for some coders and they don’t understand it despite education’— private, major city hospital, > 5 years’ experience

 - Domain: Reinforcement

  ‘Unfortunately, where I work we are always under the pump to meet the KPI so I think some people don’t record cancers due to this pressure’—private, major city hospital, > 5 years’ experience

  ‘Coders have enough KPIs to consider, including getting through a mountain of coding with an unbelievable amount of rules to follow for each and every tiny coding decision’— public, inner regional, > 5 years’ training and coding experience.

 - Environmental context and resources

  ‘The sheer number of patients requiring discussion and decision-making at my public health service MDM’— surgeon/physician, public and private major city hospitals, > 5 years’ experience

  ‘Not all the relevant information is available [at time of MDM] e.g. scan results’—surgeon/physician, public major city hospital, > 5 years’ experience

 - Knowledge

  - ‘Junior staff may not be aware of the importance of TNM’—surgeon/physician, public major city hospital, > 5 years’ experience.

 - Social influences

  ‘… we tend to discuss clinical stage in terms such as localised, locally advanced and metastatic… So we do not discuss stage in terms of TNM or AJCC.…’