Article Text
PDF
Abstract
Objective To explore patients’ and General Practitioners' (GPs) accounts of how responsibility for follow-up was perceived and shared in their experiences of cancer safety netting occurring within the past 6 months.
Design In-depth interviews were recorded and transcribed verbatim. Data were analysed through an abductive process, exploring anticipated and emergent themes. Conceptualisations of ‘responsibility’ were explored by drawing on a transactional to interdependent continuum drawing from the shared decision-making literature.
Settings and participants A purposive sample of 25 qualified GPs and 23 adult patients in Oxfordshire, UK.
Results The transactional sharing approach involves responsibility being passed from GP to patient. Patients expected and were willing to accept responsibility in this way as long as they received clear guidance from their GP and had capacity. In interdependent sharing, GPs principally aimed to reach consensus and share responsibility with the patient by explaining their rationale, uncertainty or by stressing the potential seriousness of the situation. Patients sharing this responsibility could be put at risk if no follow-up or timeframe was suggested, they had inadequate information, were falsely reassured or their concerns were not addressed at re-consultation.
Conclusion GPs and patients exchange and share responsibility using a combination of transactional and interdependent styles, tailoring information based on patient characteristics and each party’s level of concern. Clear action plans (written where necessary) at the end of every consultation would help patients decide when to re-consult. Further research should investigate how responsibility is shared within and outside the consultation, within primary care teams and with specialist services.
- neoplasms
- diagnosis
- general practice
- patient safety
- shared decision making
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Statistics from Altmetric.com
Footnotes
Contributors BDN, JE, SZ and CB conceived and designed the study. BDN is principal investigator for the study and had oversight, JE was project lead. JE conducted the interviews. JE and JIM led the data analysis. Data on the rich theme of ‘responsibility’ were also examined by members of the research team (JE, JIM, CB, BDN, SZ). All authors were involved in drafting and commenting on the paper and have approved the final version.
Funding This study was funded by a Cancer Research UK project grant through their Early Diagnosis Advisory Group (Award number C50916/A21500).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the South East Coast—Brighton & Sussex Research Ethics Committee (ref 16/LO/1468).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement De-identified transcripts from the study are archived at the Nuffield Department of Primary Care Health Sciences, University of Oxford until 31 October 2027 with participants permission, and are available under data sharing agreement to University of Oxford researchers for further analysis.