Using significant event analysis and individual audit and feedback to develop strategies to improve recognition and referral of lung and colorectal cancer at an individual general practice level

Jones, Daniel Joseph

Medicine
February 2019

Thesis or dissertation


Rights
© 2019 Daniel Joseph Jones. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
Abstract

Introduction: The lifetime risk of developing cancer is 50%. Whilst cancer survival rates are increasing, data suggests UK survival is lower than comparable countries. There is a growing evidence base to suggest cancer survival is linked at least in part, to the early recognition and referral of symptoms in primary care. The role of primary care is vital with 85% of cancers diagnosed following presentation to primary care. Significant event analyses (SEAs) are an effective tool to learn detailed lessons about the primary care interval and SEA research completed so far highlights the importance of safety netting.

Method: The research within the thesis was informed by two theories of behaviour change, the Behaviour Change Wheel and Normalisation Process Theory. The methods were split in to three distinct sections. Firstly, a scoping review of safety netting was undertaken. Secondly, the recognition and referral of lung and colorectal cancer symptoms in primary care was investigated using SEAs. Finally, the SEA data generated was used in an audit and feedback intervention to develop a series of action plans.

Findings: The definition and content of safety netting was developed. SEAs demonstrated the importance of safety netting in improving the primary care interval, but also highlighted the role of investigations, patient factors and comorbidities. SEA data was used to develop interventions which were accepted by primary care staff. Result synthesis showed the importance of safety netting and led to the development of a model.

Discussion: The importance of safety netting has been highlighted throughout the thesis. Further research is needed to evaluate the model developed. Opportunities for improving the primary care interval were highlighted. Developing interventions through audit and feedback with SEAs is feasible, and is accepted by primary care staff. The thesis has left multiple unanswered questions and could pave the way for a larger, more robust study based on the methods and techniques demonstrated.

Publisher
Hull York Medical School, The University of Hull and The University of York
Supervisor
Macleod, Una; Watt, Ian
Sponsor (Organisation)
National Institute for Health Research (Great Britain); NHS Hull Clinical Commissioning Group
Qualification level
Doctoral
Qualification name
PhD
Language
English
Extent
3 MB
Identifier
hull:17281
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