With the patient | | |
Explain the expected time course of symptoms | Useful, partly implemented | Provide further guidance for GPs on the expected time course of symptoms based on literature review |
Describe any specific warning symptoms or signs of serious disease or cancer | Limited GP response | n/a |
Give specific information about when and how best to re-consult, including specifying who is responsible for making the appointment | Useful, implemented | n/a |
Explain any uncertainty to the patient together with the reasons for tests, investigations, watchful waiting, or a trial of management | Useful, partly implemented | Longer appointments to enable time for full explanations |
Ensure patients understand safety-netting advice, with written instructions if needed, and clearly document the advice in the medical record | Useful, partly implemented | Development of patient information regarding undifferentiated symptoms; and safety-netting macros for electronic medical record system The latter would facilitate future safety-netting audits |
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Clinician actions | | |
Keep up to date with urgent referral guidelines for suspected cancer | Useful, partly implemented | An online resource collating current guidelines and referral forms. These documents could be combined so that referral forms act as an educational prompt for the referring GP |
If symptoms do not resolve, or persist intermittently, further investigations should be conducted even if previous tests were negative and referral considered (‘three strikes and you are in’) | Unhelpful in current wording | Further research with GPs to consider if and how to include such activities in safety-netting guidelines |
Perform an annual audit of new cancer diagnoses and conduct significant event analysis of delayed and emergency cancer diagnosis | Useful, implemented in different forms | Consider revising guideline to include more informal audit methodologies |
Participate in cancer awareness campaigns and screening | Deemed low priority | n/a |
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Improved systems | | |
To ensure up-to-date patient contact details | Useful, implemented | n/a |
To ensure results are viewed and acted on by someone with knowledge of cancer guidelines | Useful, implemented | Protected administration time for GPs |
To ensure patients receive test results even if they do not attend for follow-up | Useful, difficult to implement | Investment in the strengthening of primary care test-reporting systems, development of lay test-reporting templates |
To ensure consultations for unexplained recurrent symptoms are highlighted | Useful, difficult to implement | Retrospective recoding of medical records using standardised codes to repeated consultations for the same/related symptoms This would be a significant additional workload |