Developing a safety-netting intervention for the earlier diagnosis of cancer in primary care: the Shared Safety Net Action Plan (SSNAP)

Background Diagnosing cancer earlier broadens treatment options and improves survival outcomes. When symptoms do not indicate a cancer diagnosis referral, evidence suggests patients could play an important role in achieving a faster cancer diagnosis by assisting with symptom follow-up and review. Little is known about how to engage patients in diagnosis and what a safety-netting intervention involving patients in primary care might entail. Aim Stage 1 assessed components considered important for patient involvement in diagnosing cancer earlier in primary care and explored three possible strategies. Stage 2 aimed to co-design a safety-netting intervention with and for primary care patients and professionals. Method Stage 1 involved a systematic review, thematic analysis of 15 interviews with GPs, nurse practitioners and patients and a dissemination workshop with 18 stakeholders. For intervention development and refinement, stage 2 involved 3 stakeholder workshops using co-design processes; five focus groups with patients and primary care practices, underpinned by COM-B Framework. Results Stage 1: the systematic review found no interventions involving patients. Interviews identified three key themes for patient involvement: keeping the door open; roles and responsibilities; and fear of cancer. Ideally, safety-netting should involve verbal discussion and plan, written information, and optional post-consultation prompt. Stage 2: barriers and facilitators of capability, opportunity and motivation to use the intervention were identified. A safety-netting intervention for primary care was co-produced, the Shared Safety Net Action Plan (SSNAP). Conclusion Key components for patient involvement and safety-netting were identified. SSNAP is acceptable to patients and health professionals and assessment of feasibility in practice is now required.