Building the case for the use of gut-feelings in cancer referrals: perspectives of patients referred to a non-specific symptoms pathway

Background: Gut-feelings may be useful when dealing with uncertainty that is ubiquitous in primary care. Both patients and GPs experience this uncertainty but patients’ views on gut-feelings in the consultation have not been explored. Aim: To explore patients’ perceptions of gut-feelings in decision-making, and compare these perceptions to those of GPs. Design and setting: Qualitative interviews with 21 patients in Oxfordshire, UK. Methods: Patients whose referral to a cancer pathway was based on their GP’s gut-feeling were invited to participate. Semi-structured interviews were conducted November 2019-January 2020 face-to-face or over the telephone. Data were analysed with a thematic analysis and mind mapping approach. Results: Some patients described experiencing gut-feelings about their own health but often their willingness to share this with their GP was dependent on an established doctor-patient relationship. Patients expressed similar perspectives on the use of gut-feelings in consultations to those reported by GPs. Patients saw GPs’ gut-feelings as grounded in their experience and generalist expertise, and part of a process of evidence gathering. Patients suggested that GPs were justified in using gut-feelings because of their role in arranging access to investigations, the difficult ‘grey-area’ of presentations, and the time and resource limited nature of primary care. When GPs communicated that they had a gut-feeling, some saw this as an indication that they were being taken seriously. Conclusion. Patients accepted that GPs use gut-feelings to guide decision-making. Future research on this topic should include more diverse samples and address the areas of concern shared by patients and GPs.

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Administrative Work and Job Role Beliefs in Primary Care Physicians: An Analysis of Semi-Structured Interviews

SAGE Open ◽

10.1177/2158244019899092 ◽

2020 ◽

Vol 10 (1) ◽

pp. 215824401989909

Author(s):

Eric Apaydin

Keyword(s):

Primary Care ◽

Los Angeles ◽

Primary Care Physicians ◽

Theory Approach ◽

Structured Interviews ◽

Job Roles ◽

Face To Face ◽

Administrative Work ◽

Job Role ◽

The Relationship

Primary care physicians face increasing amounts of administrative work (e.g., entering notes into electronic health records, managing insurance issues, delivering test results, etc.) outside of face-to-face patient visits. The objective of this study is to qualitatively describe the experience that primary care physicians have with administrative work, with an emphasis on their beliefs about their job role. I conducted semi-structured interviews with 28 family physicians and internists in Chicago, Los Angeles, and Miami and qualitatively analyzed themes from interview transcripts using the grounded theory approach. Two major themes concerning the relationship between primary care physicians and administrative work were discovered: (a) Administrative work was not central to primary care physicians’ job role beliefs, and (b) “below license” work should be delegated to nonphysicians. Job roles should be considered in future efforts to reduce physician administrative work in primary care.

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Factors affecting general practitioners’ choice of drug therapy: A study in primary healthcare in Iceland

Læknablaðið ◽

10.17992/lbl.2021.11.660 ◽

2021 ◽

Vol 107 (11) ◽

pp. 522-527

Author(s):

Yrsa Ívarsdóttir ◽

◽

Jón Steinar Jónsson ◽

Kristján Linnet ◽

Anna Bryndís Blöndal ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

Drug Interaction ◽

Drug Therapy ◽

Primary Care Physicians ◽

New Drugs ◽

Factors Affecting ◽

Face To Face ◽

Software Information ◽

Strongly Agree

Introduction: This study aimed to analyse several factors that influence the decision-making of primary care physicians in Iceland in their choice of drug therapy for their patients. Also, to find which factors can act as a hindrance in making the best choices. Finally, to analyse which elements could be most important in facilitating decisions. Material and methods: A questionnaire was sent by e-mail to physicians working in primary care in Iceland. The questionnaire comprised closed questions, open text boxes, and ranking questions. The data was processed and analysed using Microsoft Excel. Results: The total number of primary care physicians who responded to the questionnaire was 93, a response rate of 40.7% of all the primary care physicians. The results reveal that physicians working in primary care consider clinical guidelines, the Icelandic National Formulary, and personal experience to be the most important factors when choosing a medication. Primary care physicians strongly agree that the lack of drug interaction software connected to medical records is a shortcoming. The most important factors that need improvement to facilitate primary care physicians' decision-making are drug formularies and interaction software. Conclusion: The results suggest some factors that support physicians in primary care in making decisions when choosing drug therapy, such as a drug formulary, drug interaction software, information about patients’ drug therapy, variable length in face-to-face consultations, evidence based information on new drugs, and counselling provided by clinical pharmacists.

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Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review

BJGP Open ◽

10.3399/bjgpopen20x101146 ◽

2020 ◽

pp. bjgpopen20X101146

Author(s):

Claire Duddy ◽

Geoff Wong

Keyword(s):

Primary Care ◽

Decision Making ◽

Laboratory Testing ◽

Laboratory Tests ◽

Secondary Data ◽

Realist Review ◽

Future Research ◽

Underlying Causes ◽

Important Means ◽

Test Ordering

Background: Existing research demonstrates significant variation in test-ordering practice, and growth in the use of laboratory tests in primary care. Reviews of interventions designed to change test-ordering practice report heterogeneity in design and effectiveness. Improving understanding of clinicians’ decision making in relation to laboratory testing is an important means of understanding practice patterns and developing theory-informed interventions. Aim: To develop explanations for the underlying causes of patterns of variation and increasing use of laboratory tests in primary care and make recommendations for future research and intervention design. Design and setting: Realist review of secondary data from primary care. Method: Diverse evidence including data from qualitative and quantitative studies was gathered via systematic and iterative searching processes. Data was synthesised according to realist principles to develop explanations accounting for clinicians’ decision-making in relation to laboratory tests. Results: 145 documents contributed data to the synthesis. Laboratory test ordering can fulfil many roles in primary care. Decisions about tests are incorporated into practice heuristics and tests are deployed as a tool to manage patient interactions. Ordering tests may be easier than not ordering tests in existing systems. Alongside high workloads and limited time to devote to decision-making, there is a common perception that laboratory tests are relatively inconsequential interventions. Clinicians prioritise efficiency over thoroughness in decision-making about laboratory tests. Conclusions: Interventions to change test-ordering practice can be understood as aiming to preserve efficiency or encourage thoroughness in decision-making. Intervention designs and evaluations should consider how testing decisions are made in real-world clinical practice.

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The role of mobile devices in 21st-century family communication

Mobile Media & Communication ◽

10.1177/2050157918811369 ◽

2018 ◽

Vol 7 (2) ◽

pp. 248-264 ◽

Cited By ~ 2

Author(s):

Sharon L. Storch ◽

Anna V. Ortiz Juarez-Paz

Keyword(s):

Decision Making ◽

Mobile Devices ◽

Family Communication ◽

Extended Family ◽

Emotional Responses ◽

Future Research ◽

Structured Interviews ◽

Theory Analysis ◽

The Past

Use of media devices has evolved over the past 10–15 years and the resulting effects on family communication are of interest for this study. Through 26 semi-structured interviews, the authors sought to understand the role mobile devices play in family communication. Qualitative grounded theory analysis was used to find themes and interpret results (Creswell, 2013). One overarching paradoxical theme emerged from these data, family connect–family disconnect. In family connect, categories of across distance, reassurances, and boundaries are shared. Within family disconnect, distractions, misunderstandings, and negative emotional responses are conveyed. Future research avenues recommended are decision making related to mobile devices based on values and morals, in-depth social media and app usage, emoji emotional responses, individuals under 18 and between 18 and 30 years old, and a network analysis of one extended family.

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Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England

British Journal of General Practice ◽

10.3399/bjgp20x710945 ◽

2020 ◽

Vol 70 (698) ◽

pp. e668-e675

Author(s):

Hajira Dambha-Miller ◽

Simon J Griffin ◽

Ann Louise Kinmonth ◽

Jenni Burt

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Care Provision ◽

Structured Interviews ◽

High Quality ◽

Face To Face ◽

Healthcare Experiences ◽

Provision Of Services ◽

The Impact

BackgroundThere is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses.AimTo explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses.Design and settingA qualitative primary care interview study in the East of England.MethodSemi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed.ResultsThe authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met.ConclusionType 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward.

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Student paramedics' views on placements in general practice as part of a degree

Journal of Paramedic Practice ◽

10.12968/jpar.2019.11.12.519 ◽

2019 ◽

Vol 11 (12) ◽

pp. 519-525

Author(s):

Alyesha Proctor

Keyword(s):

Primary Care ◽

General Practice ◽

Care Pathway ◽

Structured Interviews ◽

Learning And Development ◽

Alternative Care ◽

Face To Face ◽

The Uk ◽

University Degree

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.

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Policing “uncontrollable banshees”: factors influencing arrest decision making

Safer Communities ◽

10.1108/sc-05-2015-0017 ◽

2015 ◽

Vol 14 (4) ◽

pp. 183-192 ◽

Cited By ~ 3

Author(s):

Suzanne Young

Keyword(s):

Decision Making ◽

Young Women ◽

Police Officers ◽

Police Training ◽

Future Research ◽

Structured Interviews ◽

Content Type ◽

Police Decision Making ◽

Arrest Decision ◽

Determining Factor

Purpose – The purpose of this paper is to examine the factors that influence police officers’ decision making when dealing with young women considered violent. Design/methodology/approach – Semi-structured interviews were carried out with frontline police officers in Scotland on their experiences of responding to incidents where young women displayed violence. Findings – The police officers clearly distinguished encounters with women using violence from those with young men, portraying young women as irrational, unpredictable and uncontrollable. The research found that while gender alone was not a determining factor for arrest, police officers did stereotype young women according to gender norms and these norms could have a bearing on decision making. The findings show that police officers prefer to respond to situations with male perpetrators due to their own difficulties effectively communicating with young women, who are often under the influence of alcohol. Research limitations/implications – The research indicates that police officers, regardless of their gender, have difficulties handling violent incidents that involve young women. This provides scope for further analysis of police training to ascertain whether sufficient guidance is provided to fully equip police officers when faced with aggressive young women. This study focused on police officers’ own views and experiences but future research could consider a more ethnographic approach to observe police decision making in practice to determine whether the stereotypes portrayed were a true reflection of their experiences. Originality/value – This is one of only a very few studies that has explored the relation between gender and arrest decision making. It enhances the understanding of how young women come to be arrested and indicates how police officers are currently ill equipped to effectively respond to young women considered violent.

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Power and Influence Strategies in Violent and Nonviolent Marriages

Psychology of Women Quarterly ◽

10.1111/j.1471-6402.1992.tb00268.x ◽

1992 ◽

Vol 16 (4) ◽

pp. 449-465 ◽

Cited By ~ 57

Author(s):

Irene Hanson Frieze ◽

Maureen C. McHugh

Keyword(s):

Decision Making ◽

Close Relationships ◽

Physical Violence ◽

Balance Of Power ◽

Future Research ◽

Influence Strategies ◽

Structured Interviews ◽

Negative Dimension ◽

Relationship Of ◽

The Relationship

How important is the use of physical violence in determining the balance of power within marriage? Do women in violent marriages make more use of indirect strategies in attempting to persuade their husbands than do women in nonviolent marriages? Is marital satisfaction related to influence styles? These questions are investigated by looking at decision making in couples and how this is related to the forms of influence strategies used by wives and husbands in violent and nonviolent marriages. Data from in-depth structured interviews with 137 self-identified battered wives and 137 comparison wives, some of whom were also found to have experienced violence from their husbands, are used to answer these questions. Results indicated that women with violent husbands used more influence strategies overall, although these women had less overall power in terms of decision making than did women with nonviolent husbands. The relationship of influence strategies to decision making was different for women with violent husbands than for those whose husbands were not violent. As expected, the use of coercive strategies related negatively to marital happiness, whereas positive strategies were positively predictive. Violence and other negative strategies should be included in future research on influence strategies in close relationships, and a positive–negative dimension should be included as a way of categorizing influence strategies.

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ENTREPRENEURIAL DRIVE AND THE INFORMAL ECONOMY IN CAMEROON

Journal of Developmental Entrepreneurship ◽

10.1142/s1084946714500241 ◽

2014 ◽

Vol 19 (04) ◽

pp. 1450024 ◽

Cited By ~ 8

Author(s):

CHRISTOPHER F. ACHUA ◽

ROBERT N. LUSSIER

Keyword(s):

Informal Economy ◽

Developing Economies ◽

Policy Implications ◽

Future Research ◽

Structured Interviews ◽

Face To Face ◽

Formal Economy ◽

Curve Effect ◽

Street Corner ◽

Do So

There is a growing appreciation for the value and impact of the informal economy on the lives and livelihood of many in developing economies. A key question for researchers has been whether those operating in it do so out of necessity or voluntarily as opportunity seekers? Unlike previous studies that have examined the informal economy as one large block, this paper took a slightly different tangent. First, we analyzed and identified three distinct sub-groups within the informal entrepreneurial sector — the street walker (st. walker), the street corner (st. corner) and store owner (st. owner) — and then examined each group's motives. Reporting the results of face-to-face structured interviews with 200 informal entrepreneurs in Cameroon (West Africa), the finding is that the majority, especially st. walker and st. corner informal entrepreneurs, are predominantly necessity-driven while st. owner entrepreneurs are predominantly opportunity-driven. Our study also revealed a progression pattern whereby st. walkers do progress to st. corner and ultimately to st. owner entrepreneurs. The assumption is that this does create a learning curve effect in the entrepreneurial abilities and effectiveness of store owners. This is an area for future research. There are policy implications for institutional support that can grow the informal economy into the formal economy.

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Measuring transnational social fields through binational link-tracing sampling

PLoS ONE ◽

10.1371/journal.pone.0253042 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253042

Author(s):

Marian-Gabriel Hâncean ◽

Miranda Jessica Lubbers ◽

José Luis Molina

Keyword(s):

Social Network ◽

Network Analysis ◽

Sampling Design ◽

Personal Networks ◽

Future Research ◽

Structured Interviews ◽

Face To Face ◽

Social Fields ◽

Transnational Social Fields ◽

Layered Complex

We advance bi-national link-tracing sampling design, an innovative data collection methodology for sampling from so-called “transnational social fields”, i.e. transnational networks embedding migrants, returned migrants and non-migrants. This paper describes our contributions to this methodology and its empirical implementation, and evaluates the features of the resulting networks (sample), with the aim to guide future research. We performed 303 face-to-face structured interviews on sociodemographic variables, migration trajectories and personal networks of people living in a Romanian migration sending community (Dâmbovița) and in a migration receiving Spanish town (Castellón). Inter-connecting the personal networks, we built a multi-layered complex network structure embedding 4,855 nominated people, 5,477 directed ties (nominations) and 2,540 edges. Results indicate that the link-tracing nomination patterns are affected by sex and residence homophily. Our research contributes to the emerging efforts of applying social network analysis to the study of international migration.

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