scholarly journals Incorporating cancer risk information into general practice: a qualitative study using focus groups with health professionals

2017 ◽  
Vol 67 (656) ◽  
pp. e218-e226 ◽  
Author(s):  
Juliet A Usher-Smith ◽  
Barbora Silarova ◽  
Alison Ward ◽  
Jane Youell ◽  
Kenneth R Muir ◽  
...  
Keyword(s):  
General Practice ◽  
Qualitative Study ◽  
Cancer Risk ◽  
Focus Groups ◽  
Behaviour Change ◽  
Health Professionals ◽  
Lifestyle Factors ◽  
Risk Information ◽  
Lifestyle Advice ◽  
Risk Of Cancer

BackgroundIt is estimated that approximately 40% of all cases of cancer are attributable to lifestyle factors. Providing people with personalised information about their future risk of cancer may help promote behaviour change.AimTo explore the views of health professionals on incorporating personalised cancer risk information, based on lifestyle factors, into general practice.Design and settingQualitative study using data from six focus groups with a total of 24 general practice health professionals from the NHS Nene Clinical Commissioning Group in England.MethodThe focus groups were guided by a schedule covering current provision of lifestyle advice relating to cancer and views on incorporating personalised cancer risk information. Data were audiotaped, transcribed verbatim, and then analysed using thematic analysis.ResultsProviding lifestyle advice was viewed as a core activity within general practice but the influence of lifestyle on cancer risk was rarely discussed. The word ‘cancer’ was seen as a potentially powerful motivator for lifestyle change but the fact that it could generate health anxiety was also recognised. Most focus group participants felt that a numerical risk estimate was more likely to influence behaviour than generic advice. All felt that general practice should provide this information, but there was a clear need for additional resources for it to be offered widely.ConclusionStudy participants were in support of providing personalised cancer risk information in general practice. The findings highlight a number of potential benefits and challenges that will inform the future development of interventions in general practice to promote behaviour change for cancer prevention.

scholarly journals Development and usability testing of a very brief intervention for personalised cancer risk assessment to promote behaviour change in primary care using normalisation process theory

2020 ◽  
Vol 21 ◽  
Author(s):  
Katie Mills ◽  
Simon J. Griffin ◽  
Stephen Sutton ◽  
Juliet A. Usher-Smith
Keyword(s):  
Primary Care ◽  
Cancer Risk ◽  
Focus Groups ◽  
Behaviour Change ◽  
Brief Intervention ◽  
Risk Information ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Health Checks ◽  
Nhs Health Checks

Abstract Background: Cancer is the second leading cause of death worldwide. Lifestyle choices play an important role in the aetiology of cancer with up to 4 in 10 cases potentially preventable. Interventions delivered by healthcare professionals (HCPs) that incorporate risk information have the potential to promote behaviour change. Our aim was to develop a very brief intervention incorporating cancer risk, which could be implemented within primary care. Methods: Guided by normalisation process theory (NPT), we developed a prototype intervention using literature reviews, consultation with patient and public representatives and pilot work with patients and HCPs. We conducted focus groups and interviews with 65 HCPs involved in delivering prevention activities. Findings were used to refine the intervention before 22 HCPs completed an online usability test and provided further feedback via a questionnaire incorporating a modified version of the NoMAD checklist. Results: The intervention included a website where individuals could provide information on lifestyle risk factors view their estimated 10-year risk of developing one or more of the five most common preventable cancers and access lifestyle advice incorporating behaviour change techniques. Changes incorporated from feedback from the focus groups and interviews included signposting to local services and websites, simplified wording and labelling of risk information. In the usability testing, all participants felt it would be easy to collect the risk information. Ninety-one percent felt the intervention would enable discussion about cancer risk and believed it had potential to be easily integrated into National Health Service (NHS) Health Checks. However, only 36% agreed it could be delivered within 5 min. Conclusions: With the use of NPT, we developed a very brief intervention that is acceptable to HCPs in primary care and could be potentially integrated into NHS Health Checks. However, further work is needed to assess its feasibility and potential effectiveness.

scholarly journals A randomised controlled trial of the effect of providing online risk information and lifestyle advice for the most common preventable cancers

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X702893
Author(s):  
Golnessa Masson ◽  
Katie Mills ◽  
Simon J Griffin ◽  
Stephen J Sharp ◽  
William MP Klein ◽  
...  
Keyword(s):  
Risk Perception ◽  
Cancer Risk ◽  
Risk Communication ◽  
Risk Information ◽  
Lifestyle Advice ◽  
Short Term ◽  
Response Efficacy ◽  
Health Related ◽  
Reported Health ◽  
Secondary Outcomes

BackgroundPrevention offers an effective public health strategy for cancer control. One approach that could be incorporated within general practice is the provision of personalised risk information. Few trial data are available concerning the impact of cancer risk information on behaviour.AimTo assess the short-term effects on computed cancer risk and self-reported health-related behaviours of providing personalised cancer risk information.MethodA total of 1018 participants, recruited through the online platform Prolific, were randomised to either a control group receiving cancer-specific lifestyle advice alone or one of three intervention groups receiving the same lifestyle advice alongside their estimated 10-year risk of developing one of the five most common preventable cancers. Cancer risk was calculated from self-reported behavioural risk factors and presented in one of three formats: bar-chart, pictograph, or qualitative scale. The primary outcome was change from baseline in computed risk relative to an individual with a recommended lifestyle (RRI) at 3 months. Secondary outcomes included: self-reported health-related behaviours, accuracy of risk perception, risk conviction, anxiety, worry, intention to change behaviour, self-efficacy, and response-efficacy.ResultsAt immediate follow-up, accuracy of risk perception (P<0.001), risk conviction (P <0.001), and response-efficacy (P = 0.04) increased in all intervention groups. After 3 months there were no between-group differences in change in RRI (P = 0.68) or any of the secondary outcomes.ConclusionThis study has shown that a risk communication intervention can increase short-term risk accuracy and response efficacy and for the first time that risk conviction can be manipulated through risk communication. However, these effects were not sustained over time or associated with behaviour change.

scholarly journals The influence of training experiences on career intentions of the future GP workforce: a qualitative study of new GPs in England

2019 ◽  
Vol 69 (685) ◽  
pp. e578-e585 ◽  
Author(s):  
Sharon Spooner ◽  
Louise Laverty ◽  
Kath Checkland
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Qualitative Study ◽  
Focus Groups ◽  
Early Career ◽  
Situational Analysis ◽  
Career Intentions ◽  
Training Programmes ◽  
The Uk ◽  
Gp Training

BackgroundThe capacity of the UK GP workforce has not kept pace with increasing primary care workloads. Although many doctors successfully complete GP specialty training programmes, some do not progress to work in NHS general practice.AimThis article explores the training experiences and perceptions of newly qualified GPs to understand how their education, training, and early experiences of work influence their career plans.Design and settingA qualitative study of doctors in their final year of GP training (ST3) and within 5 years of completion of GP training (F5).MethodParticipants across England were recruited through training programmes, First5 groups, and publicity using social media and networks. Open narrative interviews were conducted with individuals and focus groups. Audiorecorded interviews were transcribed, and a thematic analysis was supported by NVivo and situational analysis mapping techniques.ResultsFifteen participants engaged in individual interviews and 10 focus groups were carried out with a total of 63 participants. Most doctors reported that training programmes had prepared them to deal confidently with most aspects of routine clinical GP work. However, they felt underprepared for the additional roles of running a practice and in their understanding of wider NHS organisational structures. Doctors wished to avoid unacceptably heavy workloads and voiced concerns about the longer-term sustainability of general practice.ConclusionStrategies to attract and retain enough GPs to support delivery of comprehensive primary care should consider how doctors’ early career experiences influence their career intentions. A coherent plan is needed to improve their preparation and increase confidence that they can achieve a professionally satisfying, effective, and sustainable career in NHS general practice.

scholarly journals Adapting ‘Tame Your Gut’ for patients with inflammatory bowel disease and co-morbid anxiety and/or depression

2020 ◽  
pp. 135910532094500
Author(s):  
Inna Hanlon ◽  
Catherine Hewitt ◽  
Subhadra Evans ◽  
Jo Taylor ◽  
Christian Selinger ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Qualitative Study ◽  
Focus Groups ◽  
Thematic Analysis ◽  
Bowel Disease ◽  
Health Professionals ◽  
Positive Attitude ◽  
Comorbid Anxiety ◽  
Online Psychotherapy ◽  
Inflammatory Bowel

This qualitative study collected stakeholders’ views on adapting an existing online psychotherapy programme, ‘Tame Your Gut’, to the needs of patients with inflammatory bowel disease (IBD) and comorbid anxiety and/or depression. Adult patients ( n = 13) and health professionals ( n = 12) participated in semi-structured focus groups or interviews, analysed with a thematic analysis. Patients had a generally positive attitude towards ‘Tame Your Gut’, while health professionals saw it as useful for selected patients only. Both groups indicated their preference for clinician-assisted online psychotherapy. ‘Tame Your Gut’ is acceptable to patients and health professionals but only when supported by clinicians.

scholarly journals Barriers and facilitators to implementing a cancer risk assessment tool (QCancer) in primary care: a qualitative study

2021 ◽  
Vol 22 ◽  
Author(s):  
Joseph N. A. Akanuwe ◽  
Sharon Black ◽  
Sara Owen ◽  
Aloysius Niroshan Siriwardena
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
General Practice ◽  
Cancer Risk ◽  
Focus Groups ◽  
Assessment Tool ◽  
Barriers And Facilitators ◽  
Cancer Risk Assessment ◽  
Service Users ◽  
Primary Care Practitioners

Abstract Aim: We aimed to explore service users’ and primary care practitioners’ perspectives on the barriers and facilitators to implementing a cancer risk assessment tool (RAT), QCancer, in general practice consultations. Background: Cancer RATs, including QCancer, are designed to estimate the chances of previously undiagnosed cancer in symptomatic individuals. Little is known about the barriers and facilitators to implementing cancer RATs in primary care consultations. Methods: We used a qualitative design, conducting semi-structured individual interviews and focus groups with a convenience sample of service users and primary care practitioners. Findings: In all, 36 participants (19 service users, 17 practitioners) living in Lincolnshire, were included in the interviews and focus groups. Before asking for their views, participants were introduced to QCancer and shown an example of how it estimated cancer risk. Participants identified barriers to implementing the tool namely: additional consultation time; unnecessary worry; potential for over-referral; practitioner scepticism; need for training on use of the tool; need for evidence of effectiveness; and need to integrate the tool in general practice systems. Participants also identified facilitators to implementing the tool as: supporting decision-making; modifying health behaviours; improving speed of referral; and personalising care. Conclusions: The barriers and facilitators identified should be considered when seeking to implement QCancer in primary care. In addition, further evidence is needed that the use of this tool improves diagnosis rates without an unacceptable increase in harm from unnecessary investigation.

scholarly journals Patients’ and health professionals’ perceptions of the LoDED (limit of detection and ECG discharge) strategy for low-risk chest pain management: a qualitative study

2020 ◽  
pp. emermed-2020-209539
Author(s):  
Lucy Beasant ◽  
Edward Carlton ◽  
Gareth Williams ◽  
Jonathan Benger ◽  
Jenny Ingram
Keyword(s):  
Chest Pain ◽  
Qualitative Study ◽  
Focus Groups ◽  
Health Professionals ◽  
Limit Of Detection ◽  
High Sensitivity ◽  
Patient Discharge ◽  
Information Provision ◽  
Structured Interview ◽  
Low Risk

BackgroundRapid discharge strategies for patients with low-risk chest pain using high-sensitivity troponin assays have been extensively evaluated. The adherence to, and acceptability of such strategies, has largely been explored using quantitative data. The aims of this integrated qualitative study were to explore the acceptability of the limit of detection and ECG discharge strategy (LoDED) to patients and health professionals, and to refine a discharge information leaflet for patients with low-risk chest pain.MethodsPatients with low-risk chest pain who consented to a semi-structured interview were purposively sampled for maximum variation from four of the participating National Health Service sites between October 2018 and May 2019. Two focus groups with ED health professionals at two of the participating sites were completed in April and June 2019.ResultsA discharge strategy based on a single undetectable hs-cTn test (LoDED) was acceptable to patients. They trusted the health professionals who were treating them and felt reassured by other tests, (ECG) alongside blood test(s), even when the clinical assessment did not provide a firm diagnosis. In contrast, health professionals had reservations about the LoDED strategy, including concern about identifying low-risk patients and a shortened patient observation period. Findings from 11 patient interviews and 2 staff focus groups (with 20 clinicians) centred around three overarching themes: acceptability of the LoDED strategy, perceptions of symptom severity and uncertainty, and patient discharge information.ConclusionRapid discharge for low-risk chest pain is acceptable to patients, but clinicians reported some reticence in implementing the LoDED strategy. Further work is required to optimise discharge discussions and information provision for patients.

scholarly journals Cohort profile: a nationwide cohort of Finnish military recruits born in 1958 to study the impact of lifestyle factors in early adulthood on disease outcomes

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016905 ◽  
Author(s):  
Jorma Sormunen ◽  
Melina Arnold ◽  
Isabelle Soerjomataram ◽  
Eero Pukkala
Keyword(s):  
Cancer Risk ◽  
Military Service ◽  
Early Adulthood ◽  
Lifestyle Factors ◽  
Discharge Data ◽  
Disease Outcomes ◽  
Increased Risk ◽  
Risk Of Cancer ◽  
The Impact

PurposeThe cohort was set up to study the impact of lifestyle factors in early adulthood on disease outcomes, with a focus on assessing the influence of body composition and physical performance in early adulthood on subsequent cancer risk.ParticipantsMen born in 1958 who performed their military service between the ages of 17 and 30 years were included in this study (n=31 158). They were eligible for military service if they were healthy or had only minor health problems diagnosed at the beginning of their service. Men with chronic illnesses requiring regular medication or treatment were not eligible for service. Comprehensive health data including diagnosed illnesses, anthropometric measures and health behaviour were collected at the beginning and at the end of military service, including data from medical check-ups.Findings to dateDuring the follow-up, 1124 new cancer cases were diagnosed between baseline (ie, end of the military service for each individual) and end of the year 2014. In the end of the follow-up, 91% of the study participants were still alive. Overweight (body mass index (BMI) ≥25 kg/m2) and obesity (BMI ≥30 kg/m2) were associated with an overall increased risk of cancer. A good or excellent physical condition significantly reduced cancer risk.Future plansThe dataset offers the possibility of linkage with other databases, such as the Finnish Cancer Registry (eg, primary site of the tumour, morphology, time of detection, spreading and primary treatment), vital statistics (date of emigration or deaths), censuses (socioeconomic indicators), hospital discharge data (comorbidity) and population surveys (life habits).

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