scholarly journals Does Safety Netting for Lung Cancer Symptoms Help Patients to Reconsult Appropriately? A Qualitative Study

Author(s):  
Georgia Black ◽  
Sandra van Os ◽  
Christina Renzi ◽  
Fiona Walter ◽  
Willie Hamilton ◽  
...  

Abstract Background Safety netting in primary care is considered an important intervention for managing diagnostic uncertainty. This is the first study to examine how patients understand and interpret safety netting advice around low-risk potential lung cancer symptoms, and how this affects reconsultation behaviours. Methods Qualitative dyadic interview study in UK primary care. Pre-covid-19, five patients were interviewed face-to-face twice (shortly after a primary care consultation for potential lung cancer symptom(s) and 2–5 months later). The general practitioner (GP) they last saw was interviewed face-to-face once. During the covid-19 pandemic, an additional 15 patients were interviewed once via telephone. Audio-recorded interviews were transcribed verbatim and analysed using a mix of inductive and deductive thematic analysis. Results The findings from our thematic analysis suggest that patients prefer active safety, as part of thorough and logical diagnostic uncertainty management. Passive safety netting may be perceived as dismissive and cause delayed reconsultation. GP safety netting strategies are not always understood, potentially causing patient worry and dissatisfaction. Telephone consultations and the diagnostic overshadowing of COVID-19 on respiratory symptoms impacted GPs’ safety netting strategies and patients’ appetite for active follow up measures. Conclusions Safety netting guidelines do not yet offer solutions that have been proven to promote symptom vigilance and timely reconsultation for low-risk lung cancer symptoms. Patients prefer active safety netting coupled with thorough consultation techniques and a comprehensible diagnostic strategy, and may respond adversely to passive safety netting advice.

2018 ◽  
Vol 68 (670) ◽  
pp. e333-e341 ◽  
Author(s):  
Yasemin Hirst ◽  
Anita Wey Wey Lim

BackgroundSafety netting is an important diagnostic strategy for patients presenting to primary care with potential (low-risk) cancer symptoms. Typically, this involves asking patients to return if symptoms persist. However, this relies on patients re-appraising their symptoms and making follow-up appointments, which could contribute to delays in diagnosis. Text messaging is increasingly used in primary care to communicate with patients, and could be used to improve safety netting.AimTo explore the acceptability and feasibility of using text messages to safety net patients presenting with low-risk cancer symptoms in GP primary care (txt-netting).Design and settingQualitative focus group and interview study with London-based GPs.MethodParticipants were identified using convenience sampling methods. Five focus groups and two interviews were conducted with 22 GPs between August and December 2016. Sessions were audiorecorded, transcribed verbatim, and analysed using thematic analysis.ResultsGPs were amenable to the concept of using text messages in cancer safety netting, identifying it as an additional tool that could help manage patients and promote symptom awareness. There was wide variation in GP preferences for text message content, and a number of important potential barriers to txt-netting were identified. Concerns were raised about the difficulties of conveying complex safety netting advice within the constraints of a text message, and about confidentiality, widening inequalities, and workload implications.ConclusionText messages were perceived to be an acceptable potential strategy for safety netting patients with low-risk cancer symptoms. Further work is needed to ensure it is cost-effective, user friendly, confidential, and acceptable to patients.


2021 ◽  
Author(s):  
Georgia Black ◽  
Afsana Bhuiya ◽  
Claire Friedemann-Smith ◽  
Yasmin Hirst ◽  
Brian D Nicholson

UNSTRUCTURED The management of diagnostic uncertainty is part of every primary care physician’s role. Electronic safety netting (e-safety-netting) tools are designed to assist healthcare professionals in managing diagnostic uncertainty either within or separate to the electronic healthcare record. Using software in addition to verbal and/or paper based safety-netting methods could make the process more rigorous, robust, traceable and auditable. There is no consistent definition or approach to e-safety-netting despite an increasing number of software products identifying as such and being offered to clinical teams, particularly since the COVID-19 pandemic. E-safety-netting tools have developed to perform a variety of functions including clinician alerts, administrative tasking, decision support and triggering reminder text messages to patients. However, these tools have not been evaluated using robust research designs for patient safety interventions. We present a framework of criteria for effective e-safety netting tools, to improve patient safety through more targeted development of software. The framework is based on similar criteria from electronic health record development and principles of patient safety. There are currently no tools available that meet all of the criteria in the framework. When new tools have been developed and validated through robust research, the framework will enable national and local audit and analysis, highlighting differences in performance and presenting potential solutions for improvement. We outline key areas for future research, both in primary care and within integrated care systems. E-safety-netting tools that align with the individual, social and technical aspects of primary care working are more likely to succeed.


2019 ◽  
Vol 69 (689) ◽  
pp. e869-e877 ◽  
Author(s):  
Peter J Edwards ◽  
Matthew J Ridd ◽  
Emily Sanderson ◽  
Rebecca K Barnes

BackgroundSafety netting is recommended in a variety of clinical settings, yet there are no tools to record clinician safety-netting communication behaviours.AimTo develop and assess the inter-rater reliability (IRR) of a coding tool designed to assess safety-netting communication behaviours in primary care consultations.Design and settingA mixed-methods study using an existing dataset of video-and audio-recorded UK primary care consultations.MethodKey components that should be assessed in a coding tool were identified using the published literature and relevant guidelines. An iterative approach was utilised to continuously refine and generate new codes based on the application to real-life consultations. After the codebook had been generated, it was applied to 35 problems in 24 consultations independently by two coders. IRR scores were then calculated.ResultsThe tool allows for the identification and quantification of the key elements of safety-netting advice including: who initiates the advice and at which stage of the consultation; the number of symptoms or conditions the patient is advised to look out for; what action patients should take and how urgently; as well as capturing how patients respond to such advice plus important contextual codes such as the communication of diagnostic uncertainty, the expected time course of an illness, and any follow-up plans. The final tool had substantial levels of IRR with the mean average agreement for the final tool being 88% (κ = 0.66).ConclusionThe authors have developed a novel tool that can reliably code the extent of clinician safety-netting communication behaviours.


2018 ◽  
Vol 68 (672) ◽  
pp. e505-e511 ◽  
Author(s):  
Julie Evans ◽  
Sue Ziebland ◽  
John I MacArtney ◽  
Clare R Bankhead ◽  
Peter W Rose ◽  
...  

BackgroundSafety netting is a diagnostic strategy used in UK primary care to ensure patients are monitored until their symptoms or signs are explained. Despite being recommended in cancer diagnosis guidelines, little evidence exists about which components are effective and feasible in modern-day primary care.AimTo understand the reality of safety netting for cancer in contemporary primary care.Design and settingA qualitative study of GPs in Oxfordshire primary care.MethodIn-depth interviews with a purposive sample of 25 qualified GPs were undertaken. Interviews were recorded and transcribed verbatim, and analysed thematically using constant comparison.ResultsGPs revealed uncertainty about which aspects of clinical practice are considered safety netting. They use bespoke personal strategies, often developed from past mistakes, without knowledge of their colleagues’ practice. Safety netting varied according to the perceived risk of cancer, the perceived reliability of each patient to follow advice, GP working patterns, and time pressures. Increasing workload, short appointments, and a reluctance to overburden hospital systems or create unnecessary patient anxiety have together led to a strategy of selective active follow-up of patients perceived to be at higher risk of cancer or less able to act autonomously. This left patients with low-risk-but-not-no-risk symptoms of cancer with less robust or absent safety netting.ConclusionGPs would benefit from clearer guidance on which aspects of clinical practice contribute to effective safety netting for cancer. Practice systems that enable active follow-up of patients with low-risk-but-not-no-risk symptoms, which could represent malignancy, could reduce delays in cancer diagnosis without increasing GP workload.


2019 ◽  
Vol 69 (689) ◽  
pp. e819-e826
Author(s):  
Alice Tompson ◽  
Brian D Nicholson ◽  
Sue Ziebland ◽  
Julie Evans ◽  
Clare Bankhead

BackgroundSafety netting is a diagnostic strategy that involves monitoring patients with symptoms possibly indicative of serious illness, such as cancer, until they are resolved. Optimising safety-netting practice in primary care has been proposed to improve quality of care and clinical outcomes. Introducing guidelines is a potential means to achieve this.AimTo seek the insight of frontline GPs regarding proposed safety-netting guidelines for suspected cancer in UK primary care.Design and settingA qualitative interview study with 25 GPs practising in Oxfordshire, UK.MethodTranscripts from semi-structured interviews were analysed thematically by a multidisciplinary research team using a mind-mapping approach.ResultsGPs were supportive of initiatives to optimise safety netting. Guidelines on establishing who has responsibility for follow-up, keeping patient details up to date, and ensuring test result review is conducted by someone with knowledge of cancer guidelines were already being followed. Sharing diagnostic uncertainty and ensuring an up-to-date understanding of guidelines were only partially implemented. Neither informing patients of all (including negative) test results nor ensuring recurrent unexplained symptoms are always flagged and referred were considered feasible. The lack of detail, for example, the expected duration of symptoms, caused some concern. Overall, doubts were expressed about the feasibility of the guidelines given the time, recruitment, and resource challenges faced in UK primary care.ConclusionGPs expressed general support for safety netting, yet were unconvinced that key elements of the guidelines were feasible, especially in the context of pressures on general practice staffing and time.


BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0056
Author(s):  
Stephanie Archer ◽  
Natalia Calanzani ◽  
Stephanie Honey ◽  
Margaret Johnson ◽  
Richard Neal ◽  
...  

BackgroundEarly diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic.AimTo understand GPs’ views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer.Design & settingGPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis.MethodA qualitative semi-structured interview study with GPs from the East of England.ResultsThree themes were identified across 23 interviews on GP views on the impact of: (1) patient help-seeking on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how to manage backlog in referrals.ConclusionThis study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.


Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.


2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711245
Author(s):  
Gail Davidge ◽  
Caroline Sanders ◽  
Rebecca Hays ◽  
Rebecca Morris ◽  
Helen Atherton ◽  
...  

BackgroundPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. GP contracts in England state practices must promote and offer registered patients online access to their primary care record and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access.AimTo explore patients’ views about accessing online primary care records and to find out how patients would like to interact with their records and what support they may need.MethodInterviews and focus groups with a sample of 50 patients from a variety of socio-demographic backgrounds who were either; eligible for the NHS Health Check; had multimorbidities or were carers. Thematic analysis of data identified major themes impacting upon patients’ wishes and needs as well as highlighting population-specific issues.ResultsParticipants highlighted a wide range of views about the benefits and drawbacks of accessing their records online. The majority of participants indicated that they would be more likely to access their online primary care record if improvements were made to the design, reliability and functionality of existing online record services. Carers found accessing online records particularly useful.ConclusionConsultation with patients and carers about their experiences of accessing online records; support needs and preferred functions can provide useful insights to inform the future design of online record services.


2021 ◽  
pp. 104973232098783
Author(s):  
Stacey Power ◽  
Keelin O’Donoghue ◽  
Sarah Meaney

Ireland has had a reliance on voluntary groups to provide peer-to-peer bereavement support. The aim of this study was to explore volunteers’, within these voluntary groups, experiences of supporting parents following a fatal fetal anomaly diagnosis. Purposive sampling was used to recruit volunteers ( n = 17) and face-to-face interviews undertaken. NVivo12 was utilized to assist in the thematic analysis of the data. Five themes; “motivation for altruistic acts,” “being challenged,” “value of education and training,” “supporting volunteers to support others,” and “it is not a sprint, it is a marathon” were identified. Volunteers felt comfortable in their peer-support role but found the lack of knowledge regarding newly implemented termination of pregnancy (TOP) services challenging. The importance of education/training was identified, emphasizing the need for collaboration with health care professionals and other voluntary organizations for support. The findings illustrate the need for collaborative working between health care professionals and volunteers to assist them in supporting bereaved parents.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Carly A. Conran ◽  
Zhuqing Shi ◽  
William Kyle Resurreccion ◽  
Rong Na ◽  
Brian T. Helfand ◽  
...  

Abstract Background Genome-wide association studies have identified thousands of disease-associated single nucleotide polymorphisms (SNPs). A subset of these SNPs may be additively combined to generate genetic risk scores (GRSs) that confer risk for a specific disease. Although the clinical validity of GRSs to predict risk of specific diseases has been well established, there is still a great need to determine their clinical utility by applying GRSs in primary care for cancer risk assessment and targeted intervention. Methods This clinical study involved 281 primary care patients without a personal history of breast, prostate or colorectal cancer who were 40–70 years old. DNA was obtained from a pre-existing biobank at NorthShore University HealthSystem. GRSs for colorectal cancer and breast or prostate cancer were calculated and shared with participants through their primary care provider. Additional data was gathered using questionnaires as well as electronic medical record information. A t-test or Chi-square test was applied for comparison of demographic and key clinical variables among different groups. Results The median age of the 281 participants was 58 years and the majority were female (66.6%). One hundred one (36.9%) participants received 2 low risk scores, 99 (35.2%) received 1 low risk and 1 average risk score, 37 (13.2%) received 1 low risk and 1 high risk score, 23 (8.2%) received 2 average risk scores, 21 (7.5%) received 1 average risk and 1 high risk score, and no one received 2 high risk scores. Before receiving GRSs, younger patients and women reported significantly more worry about risk of developing cancer. After receiving GRSs, those who received at least one high GRS reported significantly more worry about developing cancer. There were no significant differences found between gender, age, or GRS with regards to participants’ reported optimism about their future health neither before nor after receiving GRS results. Conclusions Genetic risk scores that quantify an individual’s risk of developing breast, prostate and colorectal cancers as compared with a race-defined population average risk have potential clinical utility as a tool for risk stratification and to guide cancer screening in a primary care setting.


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