Qualitative interview study exploring the early identification and referral of patients with suspected head and neck cancer by community pharmacists in England

Abstract

ObjectiveTo explore pharmacists’ perceptions of, and attitudes towards, the early identification and referral of patients with signs and symptoms indicating potential diagnosis of head and neck cancer (HNC) in community pharmacy settings.DesignQualitative methodology, using constant comparative analysis to undertake an iterative series of semistructured interviews. Framework analysis facilitated the identification of salient themes.SettingCommunity pharmacies in Northern England.Participants17 community pharmacists.ResultsFour salient and inter-related categories emerged: (1) Opportunity and access, indicating frequent consultations with patients presenting with potential HNC symptoms and the accessible nature of community pharmacists; (2) Knowledge gap, indicating knowledge of key referral criteria, but limited experience and expertise in undertaking more holistic patient assessments to inform clinical decision making; (3) Referral pathways and workloads; indicating good working relationships with general medical practices, but limited collaboration with dental services, and a desire to engage with formal referral pathways, but current practices based entirely on signposting resulting in a potential lack of safety-netting, no auditable trail, feedback mechanism or integration into the multidisciplinary team; (4) Utilisation of clinical decision support tools; indicating that no participants were aware the Head and Neck Cancer Risk Calculator (HaNC-RC V2) for HNC but were positive towards the use of such tools to improve decision making. HaNC-RC V2 was seen as a potential tool to facilitate a more holistic approach to assessing patient’s symptoms, acting as a prompt to further explore a patient’s presentation, requiring further investigation in this context.ConclusionsCommunity pharmacies offer access to patients and high-risk populations that could support HNC awareness initiatives, earlier identification and referral. However, further work to develop a sustainable and cost-effective approach to integrating pharmacists into cancer referral pathways is needed, alongside appropriate training for pharmacists to successfully deliver optimum patient care.

Is the early identification and referral of suspected head and neck cancers by community pharmacists feasible? A qualitative interview study exploring the views of patients in North East England

“…Research conducted alongside this study explored the views of CPs regarding their involvement in such an intervention and although it was felt to be possible to support HNC awareness initiatives, early identification and referral, the findings suggested that further work was needed to develop a sustainable and costeffective intervention. 15 This study found that regarding accessibility, there were concerns about waiting times, privacy, CP training and support, which would suggest the need to raise public awareness about the clinical role of a CP. CP capacity to deliver the intervention would also need to be assessed and reviewed locally to consider staff time and strategies to mitigate disruption.…”

“…This idea was further strengthened if the consultation included the use of the symptom‐based risk calculator, as this was designed to be quick and simple to complete and didn't require any expertise. Furthermore, as CPs tend to rely on indirect referrals, 15 or signposting, it would not make a difference who delivered the intervention if the ultimate advice was for the patient to go to their GP or GDP. The Northern Cancer Alliance has a website with an urgent referral form, but it is currently only available for GPs or GDPs to complete 22 .…”

“…While the data support the concept of CPs delivering an intervention that could lead to earlier identification and referral of HNCs in principle, there was uncertainty as to how this would work in practice. Research conducted alongside this study explored the views of CPs regarding their involvement in such an intervention and although it was felt to be possible to support HNC awareness initiatives, early identification and referral, the findings suggested that further work was needed to develop a sustainable and cost‐effective intervention 15 . This study found that regarding accessibility, there were concerns about waiting times, privacy, CP training and support, which would suggest the need to raise public awareness about the clinical role of a CP.…”

“…14 Research conducted alongside this study explored the views of CPs regarding their involvement in the early identification and referral of HNCs and found that while they would support such an intervention, further work was needed to develop a sustainable and cost-effective intervention that would include CP training for optimum patient care. 15 Clinical decision-making tools and risk calculators are available for a number of common cancers and are routinely used to aid prompt referral of high-risk individuals to specialist clinics for further assessment. [16][17][18] A validated HNC symptom-based risk assessment (www.ORLhealth.com) has been produced, which provides a straightforward web-based tool, that could potentially be used in a pharmacy setting.…”

“…In addition to the routine provision of over‐the‐counter treatments and advice for conditions that may be the result of an undetected HNC (e.g., persistent oral ulceration), CPs participate in healthy living promotion campaigns each year (e.g., smoking cessation counselling) 14 . Research conducted alongside this study explored the views of CPs regarding their involvement in the early identification and referral of HNCs and found that while they would support such an intervention, further work was needed to develop a sustainable and cost‐effective intervention that would include CP training for optimum patient care 15 …”