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GPs’ understanding and practice of safety netting for potential cancer presentations : a qualitative study in primary care
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Evans, Julie, Ziebland, Sue, MacArtney, John I., Bankhead, Clare R., Rose, Peter W. and Nicholson, Brian D. (2018) GPs’ understanding and practice of safety netting for potential cancer presentations : a qualitative study in primary care. British Journal of General Practice . bjgp18X696233. doi:10.3399/bjgp18X696233 ISSN 1478-5242.
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Official URL: http://dx.doi.org/10.3399/bjgp18X696233
Abstract
Background
Safety netting is a diagnostic strategy used in UK primary care to ensure patients are monitored until their symptoms or signs are explained. Despite being recommended in cancer diagnosis guidelines, little evidence exists about which components are effective and feasible in modern-day primary care.
Aim
To understand the reality of safety netting for cancer in contemporary primary care.
Design and setting
A qualitative study of GPs in Oxfordshire primary care.
Method
In-depth interviews with a purposive sample of 25 qualified GPs were undertaken. Interviews were recorded and transcribed verbatim, and analysed thematically using constant comparison.
Results
GPs revealed uncertainty about which aspects of clinical practice are considered safety netting. They use bespoke personal strategies, often developed from past mistakes, without knowledge of their colleagues’ practice. Safety netting varied according to the perceived risk of cancer, the perceived reliability of each patient to follow advice, GP working patterns, and time pressures. Increasing workload, short appointments, and a reluctance to overburden hospital systems or create unnecessary patient anxiety have together led to a strategy of selective active follow-up of patients perceived to be at higher risk of cancer or less able to act autonomously. This left patients with low-risk-but-not-no-risk symptoms of cancer with less robust or absent safety netting.
Conclusion
GPs would benefit from clearer guidance on which aspects of clinical practice contribute to effective safety netting for cancer. Practice systems that enable active follow-up of patients with low-risk-but-not-no-risk symptoms, which could represent malignancy, could reduce delays in cancer diagnosis without increasing GP workload.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Cancer -- Diagnosis -- Standards, Primary care (Medicine) | ||||||
Journal or Publication Title: | British Journal of General Practice | ||||||
Publisher: | Royal College of General Practitioners | ||||||
ISSN: | 1478-5242 | ||||||
Official Date: | 8 May 2018 | ||||||
Dates: |
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Article Number: | bjgp18X696233 | ||||||
DOI: | 10.3399/bjgp18X696233 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||
Date of first compliant deposit: | 7 June 2018 | ||||||
Date of first compliant Open Access: | 8 May 2019 | ||||||
RIOXX Funder/Project Grant: |
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