GPs' listening skills are a priority for patients with cancer symptoms

Patients who are experiencing symptoms that could be due to cancer are willing to wait an extra three and a half weeks for an appointment with a doctor with good listening skills, and an extra week for an appointment with a GP of their choice. In this study, Whitaker and colleagues conducted a series of experiments in which they presented over 600 participants with symptoms that could indicate differing levels of cancer risk. They found that participants expressed preferences for doctors with better listening skills, their ability to see a GP of their choice, and shorter waiting times. These results suggest that improving communication in consultations might encourage help seeking in the longer term. They also support the recommendations on cancer recognition and referral made by NICE, which advocate open and honest conversations between patients and GPs.

Blood pressure on the move

Making more blood pressure monitors available and accessible for patients in GP waiting rooms could increase the detection of high blood pressure and better enable patients being treated for high blood pressure to monitor and control their condition. Researchers from the University of Oxford found that patients without a history of high blood pressure often checked their blood pressure while waiting for a GP appointment. Those with high blood pressure self-screened to avoid the feelings they associated with ‘white coat syndrome’ and to have more control of the measurement process. The study found that patients often don't know about the availability of self-measurement and may need help with the technique. Some patients were concerned about measuring blood pressure in a public place. Several preferred monitoring their blood pressure in the waiting room, than doing it at home.

What causes late cancer presentations?

The answer to this question has, often inaccurately as it turns out, tended to be that GPs have missed the diagnosis. In an analysis of data from the English Cancer Patient Experience Survey, Abel and colleagues were able to trace the 'diagnostic route' of over 56 000 patients with a cancer diagnosis and conduct a detailed analysis of over 4600 patients who presented as emergencies. One-third of these had had no prior consultation with a GP, and only a third of the patients had had multiple consultations before the diagnosis was made. Late diagnoses were commonest in older patients and people from more socioeconomically-deprived backgrounds. These findings underline the continuing need for public health education campaigns aimed at changing patient awareness, beliefs, and behaviour about their symptoms.

Venous thromboembolism risk to care home residents

Older people in care homes have a greatly elevated risk of developing venous thromboembolic disease (VTE). Patricia Apenteng and colleagues from the universities of Birmingham and Oxford studied over 1000 care home residents, observed over 1 year, and found very substantial increases in their risk of developing VTE, but care home patients are generally not routinely assessed for this. The overall risk of definite thromboembolic events was seven times greater than the background population risk, and double that of people over the age of 70 years. The authors are cautious about making recommendations for screening or prophylaxis, but do recommend that consideration is given to risk stratification for VTE of nursing care home residents and that appropriate preventive measures are taken in those at highest risk.