How can we use innovative qualitative methods to understand the GP/patient conversation in primary care?

Problem

The National Institute for Health and Care Excellence (NICE) recognition and referral guidance for suspected cancer was updated in 2015, and as well as lowering the threshold for referring or investigating potential cancer symptoms, it underscored the importance of open and honest patient-GP conversations. However, the patient-GP conversation in relation to symptoms is not well characterised, and little is understood about what optimal interactions would involve. This video observation study uses a combination of qualitative methods to explore real-life patient GP communication about symptoms.

Approach

We are currently inviting men and women (aged 50 and over) reporting to primary care with symptoms (and their GP) to participate in video observation. We are also interviewing a sub-set of patients (n=20) and their GPs (n=10) about specific consultations. Recruitment and initial analysis will be complete by July 2018, and we will therefore be able to present our findings at the conference. A thematic analysis approach based on a subset of video recorded consultations, together with their respective patient and GP interviews will enable us to identify important themes regarding symptom description and elicitation in GP patient conversations.

Findings

Of the 261 patients approached to date across 7 GP practices, 74% consented to participate and 177 consultations with 10 GPs have been successfully recorded (173 videos, plus 4 audio-only). We have also interviewed 15 patients and 4 GPs in depth about a specific consultation. Preliminary analysis suggests that there is considerable variability in how patients present their symptoms and express expectations, as well as how GPs elicit information and negotiate decisions.

Consequences

A majority of patients are willing to allow their consultation to be recorded. In the first instance our aim is to use this rich data to develop recommendations with our expert panel including GPs, lay members, and experts in patient safety, diagnostic error and public health. The ultimate goal is to provide recommendations that will improve communication within consultations, which in turn will improve patient experience, patient safety and timely diagnosis in the context of increasing complexity in primary care practice.