Managing uncertainty for lung cancer symptoms: how is safety netting experienced and understood in practice?

Talk Code: 
Sandra van Os
Katriina Whitaker, Willie Hamilton, Fiona Walter, Christina Renzi, Colin Anderson, Georgia Black.
Author institutions: 
S van Os and G Black: Department of Applied Health Research - UCL, K Whitaker: School of Health Sciences - University of Surrey, W Hamilton: University of Exeter Medical School, F Walter: Department of Public Health and Primary Care - University of Cambridge, C Renzi: Health Behaviour Research Centre - UCL, C. Anderson: Whipps Cross Hospital patient panel


Although guidelines about safety netting in primary care exist, there is little evidence about how these strategies work in practice. Little is known about patient preferences and how GP advice affects patient behaviour after the consultation. We aimed to capture patient experiences and perspectives of safety netting, and explore possible unintended consequences of safety netting practices. Understanding how effective current strategies are and how they can be optimized in primary care will help to improve timely diagnosis and survival of lung cancer patients.


We conducted interviews with 20 participants: 15 via remote methods, and 5 face-to-face that were linked to an interview with their mostly recently visited GP (n=3). All participants had recently visited primary care for a low risk lung cancer symptom. Thanks to this dyadic design, we collected information about real examples of safety netting and uncertainty management. Participants were recruited through GP practices in deprived areas because we know that lower socioeconomic status is associated with a higher risk of late diagnosis and lower survival chances. An inductive analysis was carried out, with particular focus on the five patient-GP dyads.


GPs and patients have differing views and experiences of safety netting in the management of uncertainty around low risk lung cancer symptoms. Patients feel that uncertainty is well-managed when a GP is thorough and attentive, for example, paying attention to medical history. Most GPs perceived an effective safety net to be based on the consideration and management of cancer risk. Although many also took other steps to reassure patients. Patients strongly preferred it when the GP took active steps to encourage them to reconsult.Some unintended consequences of safety netting were uncovered: patients were sometimes unaware that GPs used certain timeframes or prescriptions to rule out alternative diagnoses. When GPs did not actively encourage patients to come back (passive safety netting) patients felt dismissed, or should not have gone to see the GP. Some patients were put off from re-seeking help due to their negative interpretation of passive safety netting.


Our findings suggest that GPs should reorient their safety netting towards ensuring that patients understand their strategy, and give active encouragement to reconsult appropriately.We argue that a health literacy Universal Precautions Approach, treating all patients as if they are at risk of not understanding advice, is imperative. This would improve patient understanding of safety netting advice, resulting in more robust mitigation of the riskier parts of the diagnostic pathway. It would also recognise that even individuals with good health literacy may not attribute the same meaning to safety netting as healthcare professionals, that health literacy can be situational, and that all patients would benefit from clear and actionable safety netting.

Submitted by: 
Sandra van Os
Funding acknowledgement: 
This project was funded by a Roy Castle Lung Cancer Foundation research grant.