GPs’ understanding and practice of safety netting for potential cancer presentations: a qualitative study in primary care

Evans, Julie; Ziébland, Sue; MacArtney, John I.; Bankhead, Clare; Rose, Peter W.; Nicholson, Brian D

doi:10.3399/bjgp18x696233

Cited by 40 publications

(49 citation statements)

References 21 publications

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“…6,26,27 Varied notions of paternalism, largely as a result of workload pressures, have also been reported in a qualitative study of GPs' practice of 'safety netting' for potential cancer presentations. 19 The range of explanations for nonattendance and their potential to increase the diagnostic interval were consistent with elements of the Andersen model of total patient delay. 11 The importance of system flaws is magnified by time pressures within an urgent referral process with performance targets.…”

Section: Comparison With Existing Literaturesupporting

confidence: 68%

“…Most GPs described follow-up whereby practice receptionists telephoned nonattending patients and at times GPs made these calls themselves; partly to enable medical discussion and to reflect the greater respect patients were felt to have for GPs. This could be seen as an example of 'safety netting', 19 though none of the GP participants used that term. Meanwhile, some GPs felt that the onus should be on the patient to attend and an informed decision not to attend should be respected: 'If they don't take you up on that offer and they've already been offered an appointment for a test and they've declined that, then I think at some point you might need to respect the patient's autonomy.'…”

Section: Negotiating Responsibilitymentioning

confidence: 99%

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Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

Jefferson¹,

Atkin²,

Sheridan³

et al. 2019

Br J Gen Pract

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BackgroundThe 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.AimTo examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance.Design and settingQualitative study in GP practices in one Northern English city.MethodIn-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.ResultsIn this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.ConclusionFailure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.

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Section: Comparison With Existing Literaturesupporting

confidence: 68%

Section: Negotiating Responsibilitymentioning

confidence: 99%

Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

Jefferson¹,

Atkin²,

Sheridan³

et al. 2019

Br J Gen Pract

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“…Consensus safety netting guidance aims to ameliorate this by stating that GPs should give specific information about when and how best to re-consult, including who has the responsibility to make the appointment 3. Our own work has shown that GPs report relying on competent patients to take the responsibility to act on that advice to re-consult once they have explained their thinking and expectations, while being more proactive in arranging follow-up for patients they perceive to be at higher risk or less able to take responsibility 25. Building on these findings, the aim of this paper is to explore patients’ and GPs’ accounts of how responsibility was perceived and shared in their own recent experiences of cancer safety netting.…”

Section: Introductionmentioning

confidence: 96%

How do GPs and patients share the responsibility for cancer safety netting follow-up actions? A qualitative interview study of GPs and patients in Oxfordshire, UK

et al. 2019

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ObjectiveTo explore patients’ and General Practitioners' (GPs) accounts of how responsibility for follow-up was perceived and shared in their experiences of cancer safety netting occurring within the past 6 months.DesignIn-depth interviews were recorded and transcribed verbatim. Data were analysed through an abductive process, exploring anticipated and emergent themes. Conceptualisations of ‘responsibility’ were explored by drawing on atransactionaltointerdependentcontinuum drawing from the shared decision-making literature.Settings and participantsA purposive sample of 25 qualified GPs and 23 adult patients in Oxfordshire, UK.ResultsThe transactional sharing approach involves responsibility being passed from GP to patient. Patients expected and were willing to accept responsibility in this way as long as they received clear guidance from their GP and had capacity. In interdependent sharing, GPs principally aimed to reach consensus and share responsibility with the patient by explaining their rationale, uncertainty or by stressing the potential seriousness of the situation. Patients sharing this responsibility could be put at risk if no follow-up or timeframe was suggested, they had inadequate information, were falsely reassured or their concerns were not addressed at re-consultation.ConclusionGPs and patients exchange and share responsibility using a combination of transactional and interdependent styles, tailoring information based on patient characteristics and each party’s level of concern. Clear action plans (written where necessary) at the end of every consultation would help patients decide when to re-consult. Further research should investigate how responsibility is shared within and outside the consultation, within primary care teams and with specialist services.

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“…These patients require appropriate and robust safety netting but, as pressures of time and workload increase in primary care, GPs report selecting patients perceived to be at higher risk for closer follow-up. 18 When safety netting patients with non-specific symptoms we should be mindful to discuss the implications of our chosen testing strategy including, as Just and colleagues 1 point out, the potential for overdiagnosis.…”

Section: Getting the Balance Rightmentioning

confidence: 99%

The elusive diagnosis of cancer: testing times

2018

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GPs’ understanding and practice of safety netting for potential cancer presentations: a qualitative study in primary care

Cited by 40 publications

References 21 publications

Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

How do GPs and patients share the responsibility for cancer safety netting follow-up actions? A qualitative interview study of GPs and patients in Oxfordshire, UK

The elusive diagnosis of cancer: testing times

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