Quality improvements of safety-netting guidelines for cancer in UK primary care: insights from a qualitative interview study of GPs.
Tompson A., Nicholson BD., Ziebland S., Evans J., Bankhead C.
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.