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GPs see potential in texts to low-risk cancer symptom patients

Text messaging could help improve care for potential cancer patients

Adrian O'Dowd

Tuesday, 27 March 2018

GPs could use text messaging to help improve their care for patients with potential symptoms of cancer, suggests a study* published today in the British Journal of General Practice (BJGP).

Researchers have called for full piloting of a system to use text messages as a way of ‘safety netting’ patients with low-risk cancer symptoms to make sure it is cost-effective, user friendly, confidential, and acceptable to patients.

Currently in the UK, around 90% of cancers present initially to GPs, but almost half of cancers in England are diagnosed at late stages due to the fact that the non-specific nature of cancer symptoms, particularly early on in its evolution, is a barrier to early diagnosis.

The approach known as ‘safety netting’ is generally considered to be an important diagnostic strategy for patients presenting to primary care with potential (low-risk) cancer symptoms.

Typically, this involves asking patients to return if symptoms persist, but it relies on patients re-appraising their symptoms and making follow-up appointments.

Researchers from University College London and Queen Mary University, London, set out to explore the acceptability and feasibility of using text messages to safety net patients presenting with low-risk cancer symptoms in primary care.

The researchers studied London-based GPs' views on text messaging in cancer 'safety netting', using a series of five focus groups and interviews conducted with 22 GPs. Sessions were recorded, transcribed and analysed using thematic analysis.

Results showed that GPs were amenable to using this new technology, realising its potential value as an additional tool to help manage patients and promote symptom awareness.

However, there was wide variation in GP preferences for the content of text messages and they had concerns about the difficulties of conveying complex ‘safety netting’ advice within the constraints of a text message, confidentiality, widening inequalities, and workload implications.

They concluded: “Further research is needed before widespread implementation of text-netting [using text messages to safety net patients presenting with low-risk cancer symptoms] in primary care is recommended.

“The next logical step is a pilot study to assess the feasibility and acceptability of text-netting in practice, taking into account the potential issues identified in this study.”

Responding to the study, Professor Helen Stokes-Lampard, chair of the RCGP, said: “Text message reminders about appointments have been used routinely for many years in some practices.

“However, we would be cautious about SMS communication with patients with, or potentially with, cancer given that there are so many sensitive psychological and emotional reactions that a person may experience as a result, and a face-to-face consultation would be more appropriate.

“But for ‘safety-netting’, whereby low-risk patients are asked to return to the GP for further tests if their symptoms that could indicate cancer persist, this research shows that text messaging can be a valuable tool in reaching out to these patients and ensuring that if they do have cancer, it is identified in a timely way.

“As with any new initiative, it would also be important to rigorously evaluate it in terms of its benefit for patients and the wider NHS before it was rolled out widely.”

*Yasemin Hirst and Anita Wey Wey Lim. Acceptability of text messages for safety netting patients with low-risk cancer symptoms: a qualitative study. British Journal of General Practice. DOI:10.3399/bjgp18X695741

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