TY - JOUR
T1 - Qualitative interview study exploring the early identification and referral of patients with suspected head and neck cancer by community pharmacists in England
AU - Sturrock, Andrew
AU - Bissett, Susan M
AU - Carrozzo, Marco
AU - Lish, Rachel
AU - Howe, Debora
AU - Mountain, Sue
AU - Nugent, Michael
AU - O'Hara, James
AU - Preshaw, Philip M.
AU - Todd, Adam
AU - Wilkes, Scott
N1 - Funding Information:
This study is funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) NorthEast and North Cumbria (NIHR ARC OFC20_30).
Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/3/7
Y1 - 2023/3/7
N2 - 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.
AB - 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.
KW - Humans
KW - Pharmacists
KW - Neoplasms
KW - Referral and Consultation
KW - England
KW - Qualitative Research
KW - PUBLIC HEALTH
KW - Head & neck tumours
KW - QUALITATIVE RESEARCH
KW - PRIMARY CARE
KW - Organisation of health services
UR - http://www.scopus.com/inward/record.url?scp=85149595960&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2022-068607
DO - 10.1136/bmjopen-2022-068607
M3 - Article
C2 - 36882255
SN - 2044-6055
VL - 13
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e068607
ER -
