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Wheelwright SJ, Russ S, Mold F, Armes J, Harder H. Symptomatic presentation of cancer in primary care: a scoping review of patients' experiences and needs during the cancer diagnostic pathway. BMJ Open 2024; 14:e076527. [PMID: 38508614 PMCID: PMC10961516 DOI: 10.1136/bmjopen-2023-076527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The objective was to map the experiences and needs of patients presenting with symptoms of suspected cancer in the primary care interval (from when they first present to primary care to their first appointment or referral to a secondary or tertiary level healthcare facility). DESIGN This was a scoping review. INCLUSION CRITERIA Studies or reports written in English which included primary data on the primary care interval experiences and/or needs of adult patients presenting with new symptoms of suspected cancer were eligible. Studies which only included patients with secondary or recurring cancer, conference abstracts and reviews were excluded. No date limits were applied. METHODS The Joanna Briggs Institute method for Scoping Reviews guided screening, report selection and data extraction. At least two independent reviewers contributed to each stage. Medline, CINAHL, PsychInfo, Embase and Web of Science were searched and several grey literature resources. Relevant quantitative findings were qualitised and integrated with qualitative findings. A thematic analysis was carried out. RESULTS Of the 4855 records identified in the database search, 18 were included in the review, along with 13 identified from other sources. The 31 included studies were published between 2002 and 2023 and most (n=17) were conducted in the UK. Twenty subthemes across four themes (patient experience, interpersonal, healthcare professional (HCP) skills, organisational) were identified. No studies included patient-reported outcome measures. Patients wanted (1) to feel heard and understood by HCPs, (2) a plan to establish what was causing their symptoms, and (3) information about the next stages of the diagnostic process. CONCLUSIONS Scoping review findings can contribute to service planning as the cancer diagnostic pathway for symptomatic presentation of cancer evolves. The effectiveness of this pathway should be evaluated not only in terms of clinical outcomes, but also patient-reported outcomes and experience, along with the perspectives of primary care HCPs.
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Affiliation(s)
| | - Stephanie Russ
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Freda Mold
- Department of Health Care Management & Policy, University of Surrey, Guildford, Surrey, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Helena Harder
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
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Fisher R, Alderwick H. The performance of general practice in the English National Health Service (NHS): an analysis using Starfield's framework for primary care. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae022. [PMID: 38770436 PMCID: PMC11103734 DOI: 10.1093/haschl/qxae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 05/22/2024]
Abstract
General practice in the English National Health Service (NHS) is in crisis. In response, politicians are proposing fundamental reform to the way general practice is organized. But ideas for reform are contested, and there are conflicting interpretations of the problems to be addressed. We use Barbara Starfield's "4Cs" framework for high-performing primary care to provide an overall assessment of the current role and performance of general practice in England. We first assessed theoretical alignment between Starfield's framework and the role of general practice in England. We then assessed actual performance using publicly available national data and targeted literature searches. We found close theoretical alignment between Starfield's framework and the model of NHS general practice in England. But, in practice, its model of universal comprehensive care risks being undermined by worsening and inequitable access, while continuity of care is declining. Underlying causes of current challenges in general practice in England appear more closely linked to under-resourcing than the fundamental design of the system. General practice in England must evolve, but wholesale re-organization is likely to damage and distract. Instead, policymakers should focus on adequately resourcing general practice while supporting general practice teams to improve the quality and coordination of local services.
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Black GB, Boswell L, Harris J, Whitaker KL. What causes delays in diagnosing blood cancers? A rapid review of the evidence. Prim Health Care Res Dev 2023; 24:e26. [PMID: 37039465 PMCID: PMC10156470 DOI: 10.1017/s1463423623000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE We undertook a rapid review of literature relating to the diagnosis of blood cancers, to find out what factors contribute to delays in diagnosis, including symptom recognition, appraisal and help-seeking behaviours. METHODS We used rapid review methodology following Tricco et al. to synthesise current literature from two electronic databases. We searched for studies about symptom appraisal help-seeking for all blood cancers published between 2001 and 2021, written in English. RESULTS Fifteen studies were included in the review, of which 10 were published in the United Kingdom. We found a number of factors associated with delays in blood cancer diagnosis. These included patient factors such as gender, age and ethnicity, as well as health system factors such as poor communication and seeing a locum clinician in primary care. A narrative synthesis of the evidence produced four types of symptom interpretation by patients: (1) symptoms compatible with normal state of health, (2) event-linked problems, (3) mild or chronic illness and (4) non-specific unwell state. These four interpretations were linked to different help-seeking behaviours. After seeking help, patients often experienced delays due to healthcare professionals' (HCPs') non-serious interpretation of symptoms, misleading blood tests, discontinuity of care and other barriers in the diagnostic pathway. CONCLUSION Blood cancers are difficult to diagnose due to non-specific heterogeneous symptoms, and this is reflected in how those symptoms are interpreted by patients and managed by HCPs. It is important to understand how different interpretations affect delays in help-seeking, and what HCPs can do to support timely follow-up for patients.
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Affiliation(s)
- Georgia B. Black
- Reader in Applied Health Research, Wolfson Institute of Population Health,
Queen Mary University of London, London,
UK
| | - Laura Boswell
- PhD student, School of Health Sciences, University of
Surrey, Guildford, UK
| | - Jenny Harris
- Senior Lecturer in Cancer Care, School of Health Sciences,
University of Surrey, Guildford,
UK
| | - Katriina L. Whitaker
- Professor of Psychology and Lead for Cancer Care, School of Health
Sciences, University of Surrey, Guildford,
UK
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Morris RL, Giles S, Campbell S. Involving patients and carers in patient safety in primary care: A qualitative study of a co-designed patient safety guide. Health Expect 2023; 26:630-639. [PMID: 36645147 PMCID: PMC10010084 DOI: 10.1111/hex.13673] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Involving patients is a key premise of national and international policies on patient safety, which requires understanding how patients or carers want to be involved and developing resources to support this. This paper examines patients' and carers' views of being involved in patient safety in primary care and their views of potentially using a co-designed patient safety guide for primary care (PSG-PC) to foster both involvement and their safety. METHODS A qualitative study using semistructured face-to-face interviews with 18 patients and/or carers in primary care. Interviews were transcribed and analysis was conducted using an inductive thematic approach. RESULTS Overall participants expressed enthusiasm for the PSG-PC as a tool to support patients and carers to be involved in patient safety in primary care. However, for some participants being involved in patient safety was seen as taking on the role of General Practitioner and had the potential to add an additional workload for patients. Participants' willingness or ability to be involved in patient safety was influenced by a range of factors including an invisible, often underacknowledged role of everyday safety for patients' interactions with primary care; the levels of involvement that patients wanted in their care and safety and the work of embedding the PSG-PC for patients into their routine interactions with primary care. Participants identified components of the PSG-PC that would be useful to them, in particular, if they had a responsibility for caring for a family member if they had more complex care or long-term conditions. CONCLUSION Involving patients and carers in patient safety needs a tailored and personalized approach that enables patients and carers to use resources like the PSG-PC routinely and helps challenge assumptions about their willingness and ability to be involved in patient safety. Doing so would raise awareness of opportunities to be involved in safety in line with personal preference. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement were central to the research study. This included working in partnership to develop the PSG-PC with patients and carers and throughout our study including in the design of the study, recruiting participants, interpretation of findings.
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Affiliation(s)
- Rebecca L Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Moffat KR, Shi W, Cannon P, Sullivan F. Factors associated with recruitment to randomised controlled trials in general practice: a systematic mixed studies review. Trials 2023; 24:90. [PMID: 36747260 PMCID: PMC9903494 DOI: 10.1186/s13063-022-06865-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 10/22/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A common challenge for randomised controlled trials (RCTs) is recruiting enough participants to be adequately powered to answer the research question. Recruitment has been set as a priority research area in trials to improve recruitment and thereby reduce wasted resources in conducted trials that fail to recruit sufficiently. METHODS We conducted a systematic mixed studies review to identify the factors associated with recruitment to RCTs in general practice. On September 8, 2020, English language studies were identified from MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and CENTRAL databases for published studies. NTIS and OpenGrey were searched for grey literature, and BMC Trials was hand searched. A narrative synthesis was conducted for qualitative studies and a thematic synthesis for qualitative studies. RESULTS Thirty-seven studies met the inclusion criteria. These were of different study types (10 cross-sectional, 5 non-randomised studies of interventions, 2 RCTs, 10 qualitative and 10 mixed methods). The highest proportion was conducted in the UK (48%). The study quality was generally poor with 24 (65%) studies having major concerns. A complex combination of patient, practitioner or practice factors, and patient, practitioner or practice recruitment were assessed to determine the possible associations. There were more studies of patients than of practices or practitioners. CONCLUSIONS For practitioners and patients alike, a trial that is clinically relevant is critical in influencing participation. Competing demands are given as an important reason for declining participation. There are concerns about randomisation relating to its impact on shared decision-making and not knowing which treatment will be assigned. Patients make decisions about whether they are a candidate for the trial even when they objectively fulfil the eligibility criteria. General practice processes, such as difficulties arranging appointments, can hinder recruitment, and a strong pre-existing doctor-patient relationship can improve recruitment. For clinicians, the wish to contribute to the research enterprise itself is seldom an important reason for participating, though clinicians reported being motivated to participate when the research could improve their clinical practice. One of the few experimental findings was that opportunistic recruitment resulted in significantly faster recruitment compared to systematic recruitment. These factors have clear implications for trial design. Methodologically, recruitment research of practices and practitioners should have increased priority. Higher quality studies of recruitment are required to find out what actually works rather than what might work. TRIAL REGISTRATION PROSPERO CRD42018100695. Registered on 03 July 2018.
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Affiliation(s)
- Keith R. Moffat
- Population and Behavioural Science Division, School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, UK
| | - Wen Shi
- Population and Behavioural Science Division, School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, UK
| | - Paul Cannon
- grid.8756.c0000 0001 2193 314XCollege Librarian Medical, Veterinary & Life Sciences, Information Services, University of Glasgow Library, Hillhead Street, Glasgow, G12 8QE UK
| | - Frank Sullivan
- Population and Behavioural Science Division, School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, UK
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Optimizing the implementation of lung cancer screening in Scotland: Focus group participant perspectives in the LUNGSCOT study. Health Expect 2022; 25:3246-3258. [PMID: 36263948 PMCID: PMC9700133 DOI: 10.1111/hex.13632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Targeted lung cancer screening is effective in reducing lung cancer and all-cause mortality according to major trials in the United Kingdom and Europe. However, the best ways of implementing screening in local communities requires an understanding of the population the programme will serve. We undertook a study to explore the views of those potentially eligible for, and to identify potential barriers and facilitators to taking part in, lung screening, to inform the development of a feasibility study. METHODS Men and women aged 45-70, living in urban and rural Scotland, and either self-reported people who smoke or who recently quit, were invited to take part in the study via research agency Taylor McKenzie. Eleven men and 14 women took part in three virtual focus groups exploring their views on lung screening. Focus group transcripts were transcribed and analysed using thematic analysis, assisted by QSR NVivo. FINDINGS Three overarching themes were identified: (1) Knowledge, awareness and acceptability of lung screening, (2) Barriers and facilitators to screening and (3) Promoting screening and implementation ideas. Participants were largely supportive of lung screening in principle and described the importance of the early detection of cancer. Emotional and psychological concerns as well as system-level and practical issues were discussed as posing barriers and facilitators to lung screening. CONCLUSIONS Understanding the views of people potentially eligible for a lung health check can usefully inform the development of a further study to test the feasibility and acceptability of lung screening in Scotland. PATIENT OR PUBLIC CONTRIBUTION The LUNGSCOT study has convened a patient advisory group to advise on all aspects of study development and implementation. Patient representatives commented on the focus group study design, study materials and ethics application, and two representatives read the focus group transcripts.
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Affiliation(s)
- Debbie Cavers
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Mia Nelson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Jasmin Rostron
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
- Present address:
The National Institute of Economic and Social Research2 Dean Trench Street, London NW1P 3HEUK
| | - Kathryn A. Robb
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Christine Campbell
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Ahsan R. Akram
- Centre for Inflammation Research and Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Graeme Dickie
- Care of the Usher InstituteUniversity of Edinburgh, EdinburghEdinburghUK
| | | | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | | | - Robert J. Steele
- School of Medicine, Ninewells HospitalUniversity of DundeeDundeeUK
| | - Aileen R. Neilson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - David Weller
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
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Tuck CZ, Akparibo R, Gray LA, Aryeetey RNO, Cooper R. What influences cancer treatment service access in Ghana? A critical interpretive synthesis. BMJ Open 2022; 12:e065153. [PMID: 36198450 PMCID: PMC9535186 DOI: 10.1136/bmjopen-2022-065153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Multiple social-cultural and contextual factors influence access to and acceptance of cancer treatment in Ghana. The aim of this research was to assess existing literature on how these factors interplay and could be susceptible to local and national policy changes. DESIGN This study uses a critical interpretive synthesis approach to review qualitative and quantitative evidence about access to adult cancer treatment services in Ghana, applying the socioecological model and candidacy framework. RESULTS Our findings highlighted barriers to accessing cancer services within each level of the socioecological model (intrapersonal, interpersonal community, organisational and policy levels), which are dynamic and interacting, for example, community level factors influenced individual perceptions and how they managed financial barriers. Evidence was lacking in relation to determinants of treatment non-acceptance across all cancers and in the most vulnerable societal groups due to methodological limitations. CONCLUSIONS Future policy should prioritise multilevel approaches, for example, improving the quality and affordability of medical care while also providing collaboration with traditional and complementary care systems to refer patients. Research should seek to overcome methodological limitations to understand the determinants of accessing treatment in the most vulnerable populations.
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Affiliation(s)
- Chloe Zabrina Tuck
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Laura A Gray
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | | | - Richard Cooper
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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8
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Jones D, Di Martino E, Bradley SH, Essang B, Hemphill S, Wright JM, Renzi C, Surr C, Clegg A, Neal R. Factors influencing symptom appraisal and help-seeking of older adults with possible cancer: a mixed-methods systematic review. Br J Gen Pract 2022; 72:BJGP.2021.0655. [PMID: 35995576 PMCID: PMC9423047 DOI: 10.3399/bjgp.2021.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/24/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The cancer burden falls predominantly on older (≥65 years) adults. Prompt presentation to primary care with cancer symptoms could result in earlier diagnosis. However, patient symptom appraisal and help-seeking decisions involving cancer symptoms are complex and may be further complicated in older adults. AIM To explore the effect of older age on patients' appraisal of possible cancer symptoms and their decision to seek help for these symptoms. DESIGN AND SETTING Mixed-methods systematic review. METHOD MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science Core Collection, ASSIA, the ISRCTN registry, and the National Institute for Health and Care Excellence were searched for studies on symptom appraisal and help-seeking decisions for cancer symptoms by adults aged ≥65 years. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-Analysis guidelines. RESULTS Eighty studies were included with a total of 32 995 participants. Studies suggested a possible association between increasing age and prolonged symptom appraisal interval. Reduced knowledge of cancer symptoms and differences in symptom interpretation may contribute to this prolonged interval. In contrast, in the current study a possible association was found between increasing age and prompt help-seeking. Themes affecting help-seeking in older adults included the influence of family and carers, competing priorities, fear, embarrassment, fatalism, comorbidities, a desire to avoid doctors, a perceived need to not waste doctors' time, and patient self-management of symptoms. CONCLUSION This review suggests that increasing age is associated with delayed cancer symptom appraisal. When symptoms are recognised as potentially serious, increasing age was associated with prompt help-seeking although other factors could prolong this. Policymakers, charities, and GPs should aim to ensure older adults are able to recognise potential symptoms of cancer and seek help promptly.
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Affiliation(s)
- Daniel Jones
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | | | | | - Blessing Essang
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Scott Hemphill
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | | | | | - Andrew Clegg
- Academic Unit for Ageing & Stroke Research, University of Leeds, Leeds
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Fish JA, Prichard I, Ettridge K, Grunfeld EA, Wilson C. Predicting men’s intentions to seek help for cancer symptoms: a comparison of the Theory of Planned Behaviour and the Health Belief Model. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1080/00049530.2022.2039042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jennifer A. Fish
- Flinders Health & Medical Research Institute, College of Medicine & Public Health, Flinders University, Adelaide, Australia
- Rosemary Bryant Ao Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Ivanka Prichard
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Kerry Ettridge
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Health Policy Centre, South Australian Health & Medical Research Institute, Adelaide, Australia
| | | | - Carlene Wilson
- Flinders Health & Medical Research Institute, College of Medicine & Public Health, Flinders University, Adelaide, Australia
- Olivia Newton John Cancer and Wellness Research Centre, Austin Health, Heidelberg, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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10
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Factors affecting the decision to investigate older adults with potential cancer symptoms: a systematic review. Br J Gen Pract 2021; 72:e1-e10. [PMID: 34782315 PMCID: PMC8597772 DOI: 10.3399/bjgp.2021.0257] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Older age and frailty increase the risk of morbidity and mortality from cancer surgery and intolerance of chemotherapy and radiotherapy. The effect of old age on diagnostic intervals is unknown; however, older adults need a balanced approach to the diagnosis and management of cancer symptoms, considering the benefits of early diagnosis, patient preferences, and the likely prognosis of a cancer. AIM To examine the association between older age and diagnostic processes for cancer, and the specific factors that affect diagnosis. DESIGN AND SETTING A systematic literature review. METHOD Electronic databases were searched for studies of patients aged >65 years presenting with cancer symptoms to primary care considering diagnostic decisions. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-analysis guidelines. RESULTS Data from 54 studies with 230 729 participants were included. The majority of studies suggested an association between increasing age and prolonged diagnostic interval or deferral of a decision to investigate cancer symptoms. Thematic synthesis highlighted three important factors that resulted in uncertainty in decisions involving older adults: presence of frailty, comorbidities, and cognitive impairment. Data suggested patients wished to be involved in decision making, but the presence of cognitive impairment and the need for additional time within a consultation were significant barriers. CONCLUSION This systematic review has highlighted uncertainty in the management of older adults with cancer symptoms. Patients and their family wished to be involved in these decisions. Given the uncertainty regarding optimum management of this group of patients, a shared decision-making approach is important.
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Pétrin J, Finlayson M, Donnelly C, McColl MA. Healthcare access experiences of persons with MS explored through the Candidacy Framework. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:789-799. [PMID: 33606904 DOI: 10.1111/hsc.13320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/14/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
Canada has one of the highest rates of multiple sclerosis (MS) in the world, affecting 1 in every 385 individuals. This neurodegenerative condition is unpredictable and variable in symptom profile and disease course making it difficult to manage. Canadians with MS are high users of healthcare services; however, they report multiple unmet needs, high disease burden, and low satisfaction with healthcare. Access to healthcare is vital to health maintenance and may explain these poor experiences. Access is often measured using utilisation as a proxy, which may fail to capture the complexities of access experiences that this population faces. The Candidacy Framework offers an alternative to utilisation measures, by examining the process of accessing care, while considering the impact of social patterning and health system environments on this process. The aim of the current study is to align the experiences of persons with MS in accessing healthcare services with the stages of the Candidacy Framework. Forty-eight individuals with MS living across Ontario were recruited to participate in one of five focus groups or ten individual interviews. Analysis included a first inductive phase, using constant comparative methods, followed by a deductive phase, using content analysis. The Candidacy Framework was not able to capture all experiences shared by persons with MS, including patient-centred care, past experiences and outcome expectation, and care outcomes. We propose these concepts be included as refinements to the current Framework, providing a more thorough explanation of the experiences of persons with MS in accessing care to manage their condition.
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Affiliation(s)
- Julie Pétrin
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Wilson F, Gardiner C. Candidates and candidacy: Patient, carer and staff perceptions of referral to a specialist palliative day unit. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1872150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- F. Wilson
- Division of Nursing & Midwifery, School of Health Sciences, University of Sheffield, Sheffield, UK
| | - C. Gardiner
- Division of Nursing & Midwifery, School of Health Sciences, University of Sheffield, Sheffield, UK
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Yan JW, Azzam D, Columbus MP, Van Aarsen K, Liu SL, Spaic T, Shepherd LG. Seeking Care for Hyperglycemia in the Emergency Department: Through the Eyes of the Patient. Diabetes Spectr 2021; 34:60-66. [PMID: 33627995 PMCID: PMC7887526 DOI: 10.2337/ds20-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Health care systems often provide a range of options of care for patients with illnesses who do not require hospital admission. For individuals with diabetes, these options may include primary care providers, specialized diabetes clinics, and urgent care and walk-in clinics. We explored the reasons why patients choose the Emergency Department over other health care settings when seeking care for hyperglycemia.
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Affiliation(s)
- Justin W. Yan
- Division of Emergency Medicine, Department of Medicine, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Dimah Azzam
- Division of Emergency Medicine, Department of Medicine, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Melanie P. Columbus
- Division of Emergency Medicine, Department of Medicine, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Kristine Van Aarsen
- Division of Emergency Medicine, Department of Medicine, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Selina L. Liu
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Joseph’s Healthcare, London, Ontario, Canada
| | - Tamara Spaic
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Joseph’s Healthcare, London, Ontario, Canada
| | - Lisa G. Shepherd
- Division of Emergency Medicine, Department of Medicine, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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De Poli C, Oyebode J, Airoldi M, Glover R. A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia. BMC Health Serv Res 2020; 20:657. [PMID: 32669104 PMCID: PMC7364635 DOI: 10.1186/s12913-020-05416-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction. METHODS Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories. RESULTS The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users' resistance to offers, users' appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need. CONCLUSION The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements.
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Affiliation(s)
- Chiara De Poli
- Department of Social Policy and Department of Management, London School of Economics and Political Science, Houghton Street, London, WC2A 2A UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, Richmond Road, Bradford, BD7 1DP UK
| | - Mara Airoldi
- Blavatnik School of Government, University of Oxford, Radcliffe Observatory Quarter, 120 Walton St, Oxford, OX2 6GG UK
| | - Richard Glover
- NHS North of England Commissioning Support, John Snow House, Durham, DH1 3YG UK
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Amelung D, Whitaker KL, Lennard D, Ogden M, Sheringham J, Zhou Y, Walter FM, Singh H, Vincent C, Black G. Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study. BMJ Qual Saf 2020; 29:198-208. [PMID: 31326946 PMCID: PMC7057803 DOI: 10.1136/bmjqs-2019-009485] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Most cancers are diagnosed following contact with primary care. Patients diagnosed with cancer often see their doctor multiple times with potentially relevant symptoms before being referred to see a specialist, suggesting missed opportunities during doctor-patient conversations. OBJECTIVE To understand doctor-patient communication around the significance of persistent or new presenting problems and its potential impact on timely cancer diagnosis. RESEARCH DESIGN Qualitative thematic analysis based on video recordings of doctor-patient consultations in primary care and follow-up interviews with patients and doctors. 80 video observations, 20 patient interviews and 7 doctor interviews across 7 general practices in England. RESULTS We found that timeliness of diagnosis may be adversely affected if doctors and patients do not come to an agreement about the presenting problem's significance. 'Disagreements' may involve misaligned cognitive factors such as differences in medical knowledge between doctor and patient or misaligned emotional factors such as patients' unexpressed fear of diagnostic procedures. Interviews suggested that conversations where the difference in views is either not recognised or stays unresolved may lead to unhelpful patient behaviour after the consultation (eg, non-attendance at specialist appointments), creating potential for diagnostic delay and patient harm. CONCLUSIONS Our findings highlight how doctor-patient consultations can impact timely diagnosis when patients present with persistent or new problems. Misalignments were common and could go unnoticed, leaving gaps for potential to cause patient harm. These findings have implications for timely diagnosis of cancer and other serious disease because they highlight the complexity and fluidity of the consultation and the subsequent impact on the diagnostic process.
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Affiliation(s)
| | | | - Debby Lennard
- Public Involvement Programme (People in Research), National Institute for Health and Care Excellence, London, UK
| | - Margaret Ogden
- Public Involvement Programme (People in Research), National Institute for Health and Care Excellence, London, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, London, UK
| | - Yin Zhou
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | | | - Georgia Black
- Department of Applied Health Research, University College London, London, UK
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O'Brien P, Bunzli S, Ayton D, Dowsey MM, Gunn J, Manski-Nankervis JA. What are the patient factors that impact on decisions to progress to total knee replacement? A qualitative study involving patients with knee osteoarthritis. BMJ Open 2019; 9:e031310. [PMID: 31551388 PMCID: PMC6773346 DOI: 10.1136/bmjopen-2019-031310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES General practitioners (GPs) are often the first health professionals to assess patients with osteoarthritis (OA). Despite clinical guideline recommendations for non-surgical intervention as first-line therapies, the most frequent referral from a GP for a person with knee OA is to an orthopaedic surgeon. The aim of our study was to explore patient factors that impact on the decision to progress to total knee replacement (TKR), including the experience of patients in general practice, their perceptions of their condition, and their access and use of community-based allied health interventions. DESIGN Qualitative investigation using semi-structured interviews. The Candidacy framework was selected as a lens to examine the factors driving healthcare access. Data were analysed using a thematic analysis approach. Codes identified in the data were mapped to the seven Candidacy domains. Themes corresponding to each domain were described. SETTING A public hospital in Melbourne, Australia. PARTICIPANTS 27 patients with knee OA who were on a waiting list to undergo TKR. RESULTS Ten themes described factors influencing access and use of non-surgical interventions and decision-making for undergoing TKR: (1) History of knee problems, change in symptoms; (2) Physical and psychosocial functioning (Identification of Candidacy); (3) GP and social networks as information sources, access to care (Navigation); (4) Referral pathways (Permeability of services); (5) Communication of impact (Appearances at health services); (6) GP-Surgeon as the predominant referral pathway (Adjudications); (7) Physical activity as painful; (8) Beliefs about effectiveness of non-surgical interventions (Offers and resistance); (9) Familiarity with local system; and (10) Availability (Operating conditions and local production of Candidacy). CONCLUSIONS Using the Candidacy framework to analyse patients' experiences when deciding to progress to TKR highlighted missed opportunities in general practice to orient patients to first try non-surgical interventions. Patients with knee OA also require improved support to navigate allied health services.
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Affiliation(s)
- Penny O'Brien
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Gunn
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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