Qualitative interview study exploring the early identification and referral of patients with suspected head and neck cancer by community pharmacists in England

Sturrock, Andrew, Bissett, Susan M., Carrozzo, Marco, Lish, Rachel, Howe, Debora, Mountain, Sue, Nugent, Michael, O'Hara, James, Preshaw, Philip M., Todd, Adam and Wilkes, Scott (2023) Qualitative interview study exploring the early identification and referral of patients with suspected head and neck cancer by community pharmacists in England. BMJ Open, 13 (3). e068607. ISSN 2044-6055

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Abstract

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.

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