Qualitative interview study exploring the early identification and referral of patients with suspected head and neck cancer by community pharmacists in England

Andrew Sturrock (Lead / Corresponding author), Susan M Bissett, Marco Carrozzo, Rachel Lish, Debora Howe, Sue Mountain, Michael Nugent, James O'Hara, Philip M. Preshaw, Adam Todd, Scott Wilkes

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
8 Downloads (Pure)


Objective: To explore pharmacists' perceptions of, and attitudes towards, the early identification and referral of patients with signs and symptoms indicating potential diagnosis of head and neck cancer (HNC) in community pharmacy settings.

Design: Qualitative methodology, using constant comparative analysis to undertake an iterative series of semistructured interviews. Framework analysis facilitated the identification of salient themes.

Setting: Community pharmacies in Northern England.

Participants: 17 community pharmacists.

Results: Four salient and inter-related categories emerged: (1) Opportunity and access, indicating frequent consultations with patients presenting with potential HNC symptoms and the accessible nature of community pharmacists; (2) Knowledge gap, indicating knowledge of key referral criteria, but limited experience and expertise in undertaking more holistic patient assessments to inform clinical decision making; (3) Referral pathways and workloads; indicating good working relationships with general medical practices, but limited collaboration with dental services, and a desire to engage with formal referral pathways, but current practices based entirely on signposting resulting in a potential lack of safety-netting, no auditable trail, feedback mechanism or integration into the multidisciplinary team; (4) Utilisation of clinical decision support tools; indicating that no participants were aware the Head and Neck Cancer Risk Calculator (HaNC-RC V2) for HNC but were positive towards the use of such tools to improve decision making. HaNC-RC V2 was seen as a potential tool to facilitate a more holistic approach to assessing patient's symptoms, acting as a prompt to further explore a patient's presentation, requiring further investigation in this context.

Conclusions: Community pharmacies offer access to patients and high-risk populations that could support HNC awareness initiatives, earlier identification and referral. However, further work to develop a sustainable and cost-effective approach to integrating pharmacists into cancer referral pathways is needed, alongside appropriate training for pharmacists to successfully deliver optimum patient care.

Original languageEnglish
Article numbere068607
Number of pages8
JournalBMJ Open
Issue number3
Early online date7 Mar 2023
Publication statusPublished - 7 Mar 2023


  • Humans
  • Pharmacists
  • Neoplasms
  • Referral and Consultation
  • England
  • Qualitative Research
  • Head & neck tumours
  • Organisation of health services

ASJC Scopus subject areas

  • General Medicine


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