Patient safety netting to catch cancer
In a guest blog, GP and Doctoral Research Fellow at the Nuffield Department of Primary Health Care Sciences, Dr Brian Nicholson, explains how cancer safety netting can keep patients from harm.
Every day, thousands of people across the country visit their doctor with symptoms that could be a sign of cancer. While some may have easily recognisable high risk symptoms, such as difficulty swallowing (dysphagia) or coughing up blood (haemoptysis), the vast majority will have vague or non-specific symptoms like a cough, fatigue, or abdominal pain, where the likelihood of cancer is low.
Doctors must balance the risk between causing unnecessary alarm and wasting scarce resources through over-investigation, with the potential harm of delaying a diagnosis of serious disease.
The current best practice recommended for cancer diagnosis is ‘safety netting’ – a way of allowing doctors to spot serious disease by following up patients over time. The goal is to ensure that patients do not drop through the healthcare net, by monitoring them until their symptoms are explained.
This includes explaining uncertainty about the cause of symptoms and making sure patients receive test results, even if they do not attend a follow-up appointment.
However, there is little evidence on whether safety netting improves cancer detection and how best to apply this method for patients with vague symptoms.
Dr Brian Nicholson and colleagues at the University of Oxford have recently searched for evidence on how safety netting can be done effectively, and have published their findings of a study funded by Cancer Research UK in The BMJ.
Although their research found no apparent evidence on whether safety netting is effective, they did find evidence on the necessary components of safety netting, the roles of the patient and doctor, and the problems arising from miscommunication or misinterpretation of initial test results.
Based on this evidence, the authors recommend that doctors explain uncertainty about the cause of symptoms with patients, ensuring they understand why, when and with whom they should re-consult about concerning symptoms. Systems should also be put in place to ensure that test results are reviewed by somebody with knowledge of cancer guidelines, and that positive and negative results are communicated to the patient promptly.
Although the evidence base is uncertain, safety netting remains the best option, and is likely better than nothing. It is important that patients continue to visit their doctor until their symptoms are explained. We know that doctors are safety netting every day to keep their patients safe. By conducting research on safety netting we will be able to understand which safety netting messages and systems are effective.
The full findings of the report can be read in The BMJ.