Patient and practitioner views on cancer risk discussions in primary care: a qualitative study

BackgroundIt is estimated that nearly 600,000 cancer cases in the UK could have been avoided in the last five years if people had healthier lifestyles, with the principle modifiable risk factors being smoking, obesity, alcohol consumption and inactivity. There is growing interest in the use of cancer risk information in general practice to encourage lifestyle modification.AimTo explore the views and experiences of patients and practitioners in relation to cancer prevention and cancer risk discussions in general practice.Design & settingQualitative study among patient and practitioners in general practices in Glasgow, UK.MethodSemi-structured interviews were conducted with nine practitioners (5 GPs and four practice nurses, recruited purposively from practices based on list size and deprivation status) and 13 patients (aged 30–60, with two or more specified co-morbidities).ResultsCurrently, cancer risk discussions focus on smoking and cancer, with links between alcohol/obesity and cancer rarely made. There was support for the use of the personalised cancer risk tool as an additional resource in primary care. Practitioners felt practice nurses were best placed to use it. Use in planned appointments (eg, chronic disease reviews) was preferred over opportunistic use. Concerns were expressed, however, about generating anxiety, time constraints, and widening inequalities.ConclusionsHealth behaviour change is complex and the provision of information alone is unlikely to have significant effects. Personalised risk tools may have a role, but important concerns about their use – particularly in areas of socio-economic disadvantage – remain.

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Experiences of support from primary care and perceived needs of parents bereaved by suicide: a qualitative study

British Journal of General Practice ◽

10.3399/bjgp20x707849 ◽

2020 ◽

Vol 70 (691) ◽

pp. e102-e110 ◽

Cited By ~ 1

Author(s):

Verity Wainwright ◽

Lis Cordingley ◽

Carolyn A Chew-Graham ◽

Nav Kapur ◽

Jenny Shaw ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Qualitative Study ◽

Support Needs ◽

Structured Interviews ◽

Perceived Needs ◽

The North ◽

Suicide Bereavement ◽

Additional Support ◽

The Uk

BackgroundPeople bereaved by suicide are a vulnerable group, also at risk of dying by suicide. The importance of postvention support (intervention after suicide) has recently been highlighted; however, little is known about the support needs of parents bereaved by suicide in the UK, and the role played by general practice.AimTo explore the perspectives, experiences, and support needs of parents bereaved by suicide.Design and settingThis was a qualitative study, with semi-structured interviews conducted between 2012 and 2014 in the north of England and the Midlands, with parents bereaved by their son or daughter’s suicide.MethodInterviews explored parents’ experiences of suicide bereavement following the death of their son or daughter, with a focus on their experiences of support from primary care. Interviews were analysed thematically using constant comparison.ResultsTwenty-three interviews were conducted. Three themes were identified from the data: the importance of not feeling alone; perceived barriers to accessing support; and the need for signposting for additional support. Some parents reported having experienced good support from their general practice; others described a number of barriers to accessing help, including triage processes. Primary care was considered to be an important avenue of support but GPs were often perceived as uncertain how to respond. The need for information, signposting to avenues of support, and the helpfulness of group support were also highlighted.ConclusionParents believed it was important that people working in general practice have an awareness of suicide bereavement and understanding of their needs, including knowledge of where to direct people for further support.

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

British Journal of General Practice ◽

10.3399/bjgp19x703877 ◽

2019 ◽

Vol 69 (685) ◽

pp. e578-e585 ◽

Cited By ~ 5

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.

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

Primary Health Care Research & Development ◽

10.1017/s1463423621000281 ◽

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.

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Strategies supporting sustainable prescribing safety improvement interventions in english primary care: qualitative study

BJGP Open ◽

10.3399/bjgpo.2021.0109 ◽

2021 ◽

pp. BJGPO.2021.0109

Author(s):

Azwa Shamsuddin ◽

Mark Jeffries ◽

Aziz Sheikh ◽

Libby Laing ◽

Nde-Eshimuni Salema ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Qualitative Study ◽

Sustainable Use ◽

Clinical Decision ◽

Successful Implementation ◽

Structured Interviews ◽

Documentary Analysis ◽

Safety Improvement ◽

Template Analysis

BackgroundWhilst the use of prescribing safety indicators (PSI) can reduce potentially hazardous prescribing, there is a need to identify actionable strategies for the successful implementation and sustainable delivery of PSI-based interventions in general practice.AimTo identify strategies for the successful implementation and sustainable use of PSI-based interventions in routine primary care.Design & settingQualitative study in primary care settings across England.MethodAnchoring on a complex pharmacist-led IT-based intervention (PINCER) and clinical decision support (CDS) for prescribing and medicines management, we conducted a qualitative study using sequential, multiple methods which comprised of documentary analysis, semi-structured interviews and online workshops to identify challenges and possible solutions to the longer-term sustainability of PINCER and CDS. Thematic analysis was used for the documentary analysis and stakeholder workshops, whilst template analysis was used for the semi-structured interviews. Findings across the three methods were synthesised using the RE-AIM framework.ResultsWe analysed 48 documents, undertook 27 interviews and two workshops involving 20 participants. Five main issues were identified, which aligned with the adoption and maintenance dimensions of RE-AIM: fitting into current context (adoption); engaging hearts and minds (maintenance); building resilience (maintenance); achieving engagement with secondary care (maintenance); and emphasising complementarity (maintenance).ConclusionsExtending ownership of prescribing safety beyond primary care-based pharmacists and achieving greater alignment between general practice and hospital prescribing safety initiatives is fundamental to achieve sustained impact of PSI-based interventions in primary care.

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GPs’ experiences and perceptions of early detection of liver disease: a qualitative study in primary care

British Journal of General Practice ◽

10.3399/bjgp18x699377 ◽

2018 ◽

Vol 68 (676) ◽

pp. e743-e749 ◽

Cited By ~ 8

Author(s):

Holly C Standing ◽

Helen Jarvis ◽

James Orr ◽

Catherine Exley ◽

Mark Hudson ◽

...

Keyword(s):

Primary Care ◽

Liver Disease ◽

Qualitative Study ◽

Early Detection ◽

Liver Function Tests ◽

Comparative Approach ◽

Structured Interviews ◽

Alcoholic Fatty Liver ◽

Study Sites ◽

The Uk

BackgroundThe incidence of liver disease is increasing in the UK and primary care is a key setting where improvement in the detection and management of liver disease is required. Little is known about GPs’ understanding and confidence in detecting liver disease.AimTo explore GPs’ experiences of liver disease with a focus on early detection and interpretation of liver function tests (LFTs).Design and settingA qualitative study employing semi-structured interviews of a purposive sample of GPs from five UK primary care study sites.MethodTelephone and face-to-face interviews of GPs were undertaken. Data were analysed thematically, using a constant comparative approach.ResultsFrom a total of 25 GP interviews (N = 25), four themes were identified from the data: test-requesting behaviour, confidence and challenges in diagnosing disease, access to specialist tests, and guidance and education. Participants’ descriptions of how they request and interpret LFTs varied widely. Concern over missing diagnoses was a common reason for requesting blood tests; patients with mildly abnormal LFTs and those at risk of non-alcoholic fatty liver disease (NAFLD) were a particular cause of concern. GPs saw themselves as generalists, with a reluctance to take on specialist investigations. Guidelines promoted confidence for some clinicians, but others felt that liver disease was too complex to be amenable to simple instructions. Most felt that they did not have access to relevant, focused education on liver disease.ConclusionLiver disease is not perceived as a priority in primary care. If GPs are to take on a greater role in identification and management of liver disease, support is needed to promote awareness, knowledge, and confidence.

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GPs’ experiences of diagnosing and managing childhood eczema: a qualitative study in primary care

British Journal of General Practice ◽

10.3399/bjgp18x694529 ◽

2018 ◽

Vol 68 (667) ◽

pp. e73-e80 ◽

Cited By ~ 7

Author(s):

Emma Le Roux ◽

Kingsley Powell ◽

Jonathan P Banks ◽

Mathew J Ridd

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Disease Control ◽

Medication Use ◽

Self Care ◽

Trial And Error ◽

Structured Interviews ◽

Common Cause ◽

Topical Treatments ◽

The Uk

BackgroundEczema is common among children, and in the UK the majority are managed by GPs. The most common cause of poor disease control is incorrect use of topical treatments. There is a lack of research into the challenges faced by GPs in diagnosing and managing this condition.AimTo explore the experiences of GPs in assessing and managing children with eczema.Design and settingQualitative study in primary care in England.MethodSemi-structured interviews with 15 GPs were audiorecorded, transcribed verbatim, and analysed thematically using the framework method.ResultsGPs described a paucity of dermatology training. Although most GPs were confident diagnosing uncomplicated eczema, they reported using a trial-and-error approach to prescribing emollients, and were uncertain about quantities of topical treatments to issue. Mild and moderate potency topical corticosteroids (TCS) were commonly used, but most GPs lacked confidence in recommending potent TCS, and viewed parents or carers to be fearful of using all strengths of TCS. GPs perceived adherence to treatments to be low, but provision of information to support self-care was variable. Routine review of medication use or disease control was uncommon, which GPs attributed to service constraints. Participants’ views on the causes and management of eczema were perceived to be at odds with parents and carers, who were said to be overly focused on an underlying cause, such as allergy.ConclusionGP uncertainty in managing eczema, lack of routine information and review, and perceived dissonance with parents around causation and management may be contributing to low concordance with treatments.

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An ethnographic exploration of the social organisation of general practice nurses’ knowledge use: more than ‘mindlines’?

Journal of Research in Nursing ◽

10.1177/1744987120937411 ◽

2020 ◽

Vol 25 (6-7) ◽

pp. 604-615

Author(s):

Judith Carrier

Keyword(s):

Primary Care ◽

General Practice ◽

Healthcare Delivery ◽

Contextual Influences ◽

Knowledge Use ◽

Practice Nurses ◽

Rural Primary Care ◽

Knowledge Practice ◽

The Uk ◽

Primary Care Practices

Aim To explore contextual, organisational and educational issues impacting on access to, and application of knowledge to everyday practice by general practice nurses, working in two rural primary-care practices in the UK. Background Changes in primary-care healthcare delivery have resulted in substantive changes to practice nurses’ roles. Practice nurses have taken on enhanced roles for which they were not prepared for in their initial training, little is known about how they access and apply knowledge. Methods Ethnographic methods were used to gather data. Results Practice nurses take a blended approach to knowledge use, using elements of evidence-based practice to support professional judgement. This is subject to several contextual influences, organisational, educational and from individual patients. Tensions exist between the position in which general practice nurses are situated and the nature in which knowledge is disseminated and used in primary care. Whilst examples of clinical mindlines were evident, these differed to those previously observed in general practitioners, practice nurses did not always have the mindline on which to draw and used an approach to practice that resembled ‘bricoleur activity’. Conclusions The way in which general practice is structured results in variance in organisational structural arrangements for sharing and disseminating of knowledge. Despite a supportive organisational culture towards knowledge sharing, the position in which practice nurses are situated limits opportunities for discussion and reformulation of knowledge. Practice nurses are, however, prepared to adapt knowledge to meet the needs of individual patients.

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Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory

BMJ Open ◽

10.1136/bmjopen-2019-029914 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029914

Author(s):

Carl de Wet ◽

Paul Bowie ◽

Catherine A O'Donnell

Keyword(s):

General Practice ◽

Qualitative Study ◽

Process Theory ◽

Normalisation Process Theory ◽

Science Literature ◽

Leadership Roles ◽

Structured Interviews ◽

Theoretical Frameworks ◽

Practice Nurses ◽

Healthcare Interventions

ObjectivesPatient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting.DesignQualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT).SettingScottish general practice.ParticipantsWe conducted 28 semistructured interviews with general practitioners (n=12), practice nurses (n=11) and practice managers (n=5) in Scotland.ResultsWe identified four important factors that facilitated or hindered implementation: (1) the amount of time and allocated resources; (2) integration of the TRM into existing initiatives and frameworks facilitated implementation and justified participants’ involvement; (3) the characteristics of the reviewers—implementation was facilitated by experienced, reflective clinicians with leadership roles in their teams; (4) the degree to which participants perceived the TRM as acceptable, feasible and useful.ConclusionsThis study is the first known attempt to investigate how the TRM is implemented and perceived by general practice clinicians and staff. The four main factors that facilitated TRM implementation are comparable with the wider implementation science literature, suggesting that a small number of specific factors determine the success of most, if not all, complex healthcare interventions. These factors can be identified, described and understood through theoretical frameworks such as NPT and are amenable to intervention. Researchers and policymakers should proactively identify and address these factors.

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