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Research

Quality improvements of safety-netting guidelines for cancer in UK primary care: insights from a qualitative interview study of GPs

Alice Tompson, Brian D Nicholson, Sue Ziebland, Julie Evans and Clare Bankhead
British Journal of General Practice 2019; 69 (689): e819-e826. DOI: https://doi.org/10.3399/bjgp19X706565
Alice Tompson
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
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Brian D Nicholson
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
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Sue Ziebland
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
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Julie Evans
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
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Clare Bankhead
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
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Abstract

Background Safety netting is a diagnostic strategy that involves monitoring patients with symptoms possibly indicative of serious illness, such as cancer, until they are resolved. Optimising safety-netting practice in primary care has been proposed to improve quality of care and clinical outcomes. Introducing guidelines is a potential means to achieve this.

Aim To seek the insight of frontline GPs regarding proposed safety-netting guidelines for suspected cancer in UK primary care.

Design and setting A qualitative interview study with 25 GPs practising in Oxfordshire, UK.

Method Transcripts from semi-structured interviews were analysed thematically by a multidisciplinary research team using a mind-mapping approach.

Results GPs were supportive of initiatives to optimise safety netting. Guidelines on establishing who has responsibility for follow-up, keeping patient details up to date, and ensuring test result review is conducted by someone with knowledge of cancer guidelines were already being followed. Sharing diagnostic uncertainty and ensuring an up-to-date understanding of guidelines were only partially implemented. Neither informing patients of all (including negative) test results nor ensuring recurrent unexplained symptoms are always flagged and referred were considered feasible. The lack of detail, for example, the expected duration of symptoms, caused some concern. Overall, doubts were expressed about the feasibility of the guidelines given the time, recruitment, and resource challenges faced in UK primary care.

Conclusion GPs expressed general support for safety netting, yet were unconvinced that key elements of the guidelines were feasible, especially in the context of pressures on general practice staffing and time.

  • diagnosis
  • general practice
  • neoplasms
  • patient safety
  • qualitative research
  • Received April 22, 2019.
  • Revision requested May 14, 2019.
  • Accepted June 7, 2019.
  • © British Journal of General Practice 2019
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British Journal of General Practice: 69 (689)
British Journal of General Practice
Vol. 69, Issue 689
December 2019
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Quality improvements of safety-netting guidelines for cancer in UK primary care: insights from a qualitative interview study of GPs
Alice Tompson, Brian D Nicholson, Sue Ziebland, Julie Evans, Clare Bankhead
British Journal of General Practice 2019; 69 (689): e819-e826. DOI: 10.3399/bjgp19X706565

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Quality improvements of safety-netting guidelines for cancer in UK primary care: insights from a qualitative interview study of GPs
Alice Tompson, Brian D Nicholson, Sue Ziebland, Julie Evans, Clare Bankhead
British Journal of General Practice 2019; 69 (689): e819-e826. DOI: 10.3399/bjgp19X706565
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Keywords

  • diagnosis
  • general practice
  • neoplasms
  • patient safety
  • qualitative research

More in this TOC Section

  • Evaluation of a primary care-based opioid and pain review service: a mixed-methods evaluation in two GP practices in England
  • Development of a tool for coding safety-netting behaviours in primary care: a mixed-methods study using existing UK consultation recordings
  • Benefits and harms of aspirin to reduce colorectal cancer risk: a cross-sectional study of methods to communicate risk in primary care
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Print ISSN: 0960-1643
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