Background: Although shared decision-making (SDM) is key to delivering patient-centred care, there are barriers to general practitioners (GPs) implementing SDM in practice. SDM training is undergoing development by organisations, including the Royal College of General Practitioners. However, GPs’ perceptions of the delivery of SDM training in general practice remain largely unexplored. Aim: To explore GPs’ perceptions of teaching methods in SDM training. Design and Setting: A qualitative study of GPs with teaching roles at the University of Exeter Medical School was conducted. Method: Purposive sampling recruited 14 GPs. Semi-structured interviews explored their SDM educational experiences. Data were analysed using thematic framework analysis. Results: Three themes were identified. The GPs described role-play, receiving feedback, and on-the-job learning as modes of delivering SDM training that positively informed their SDM in clinical practice. Learning from knowledgeable individuals and using realistic patient cases were perceived as beneficial components of SDM learning, though most learning occurred implicitly through reflections on their clinical experiences. The GPs identified the incorporation of the uncertainty that is present in general practice consultations; targeting of individual GPs’ SDM learning needs and explanation of the potential benefits of SDM on consultation outcomes as important methods to facilitate the implementation of SDM in practice. Conclusion: This is the first UK study to explore GPs’ perceptions of SDM training and provide recommendations for practice. As SDM occurs in partnership with patients, further research should obtain and incorporate patients' views alongside those of GPs in the evaluation of future programmes.
ObjectiveThis paper presents a case of an isolated pituitary fossa metastasis on a background of a previously treated tonsillar squamous cell carcinoma.Case reportA 64-year-old male, diagnosed with a primary p16-negative squamous cell carcinoma in the right tonsil, was treated with a course of chemoradiotherapy with curative intent. Positron emission tomography/computed tomography, performed at six months post-treatment, revealed a good local response and no distant metastases. The patient was placed on routine follow up at two-monthly intervals. Two months into follow up, he presented with a right-sided oculomotor nerve palsy and partial Horner's syndrome. Imaging and biopsy revealed a pituitary fossa metastasis (p16-negative squamous cell carcinoma), and a further positron emission tomography/computed tomography visualised this lesion. He was deemed unsuitable for further intervention and underwent palliative radiotherapy for symptom control.ConclusionThis case represents the first reported isolated pituitary fossa metastasis from a tonsillar squamous cell carcinoma. A high degree of clinical suspicion is recommended, along with a low threshold for biopsy and a cautioned use of positron emission tomography/computed tomography, when investigating such patients.
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