Acceptability of text messages for safety netting patients with low-risk cancer symptoms: a qualitative study

Abstract

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.

Safety netting for primary care: evidence from a literature review

“…13,[33][34][35][36] Twelve citations were studies using qualitative methods including five interview methods, [37][38][39][40][41] two questionnaire methods, 7,42 and five mixedmethod studies. [43][44][45][46][47] Of the remaining…”

O uso do WhatsApp na relação médico-paciente

“…Another advantage mentioned was the speed of communication provided by the technology. This advantage was cited by only one of the respondents (12.5%) of this research, but was cited by most of the interviewees from other studies [22][23][24] .…”

“…Among the disadvantages related to WhatsApp in the doctor-patient relationship mentioned by the interviewees is the trivialisation of the medical service by the patients (25%). Another study 22 demonstrated that, in fact, more accurate clinical data are necessary for good care and many times the data can not be sent using the application (due to lack of resource or knowledge of the person passing the information). This justifies the dissatisfaction of doctors with a service centred solely on the exchange of messages online.…”

“…The fact that patients no longer wish to go to face-to-face medical appointments after the possibility of having appointments using WhatsApp was mentioned by 25% of respondents. This is a justified concern because physical examination is still necessary 20,22 even if the application supports clinical care. Pictures sent by patients may not be of sufficient quality, making it difficult to properly diagnose and increasing the possibility of error 20 .…”

Safety netting: now doctors need it too

“…One virtue of seeding an idea like safety netting into the mind in an unfinished form is that, like a grain of sand in an oyster, it can niggle something unexpected and valuable into existence. The paper by Hirst and Lim, 7 where they describe using text messaging to follow up patients who presented with possible cancer symptoms, is an example. By hitching a common clinical anxiety to a popular technology, they have created an innovation that 'early adopter' GPs will enjoy developing, and that will probably save some lives.…”