lnu.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Thulesius, Hans
Publications (10 of 61) Show all publications
Sanden, U., Nilsson, F., Thulesius, H., Hägglund, M. & Harrysson, L. (2019). Cancer, a relational disease exploring the needs of relatives to cancer patients. International Journal of Qualitative Studies on Health and Well-being, 14(1), Article ID 1622354.
Open this publication in new window or tab >>Cancer, a relational disease exploring the needs of relatives to cancer patients
Show others...
2019 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1622354Article in journal (Refereed) Published
Abstract [en]

Purpose: In this qualitative interview study we investigated the experiences of family members to cancer patients. Our objective was to explore and to differentiate their needs from the needs of cancer patients. Methods: Five focus groups and six individual narrative interviews with 17 family members to cancer patients in Sweden were conducted and compared with 19 cancer patient interviews. Our analysis was inspired by classic grounded theory. Results: Family members to cancer patients expressed own morbidity connected to high stress levels and difficulties in recognizing own stress due to ongoing comparisons with the cancer patient. Family members were trapped in a momentary terror-like situation where they became their sick relative's safety net. A percieved inability to improve their loved one's well being contributed to a feeling of guilt. The longing for it all to end was encumbered with shame since the end included possible death. Conclusions: By recognizing cancer as a disease striking both body and relationships, family members are given precedence over their own struggles, differentiated from the patient's experiences. We define differences in needs between cancer patients and family members. Family members to cancer patients may be supported in developing balancing strategies towards less stress, increased safety and moments of contentment.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Health, family members, carers, cancer care, grounded theory, waiting, safety, momentary contentment, salutogenesis, informal caregiver
National Category
Other Health Sciences
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-84845 (URN)10.1080/17482631.2019.1622354 (DOI)000468976100001 ()31122166 (PubMedID)2-s2.0-85066847390 (Scopus ID)
Available from: 2019-06-12 Created: 2019-06-12 Last updated: 2019-08-29Bibliographically approved
Melin, E. O., Thulesius, H., Hillman, M., Svensson, R., Landin-Olsson, M. & Thunander, M. (2019). Lower HDL, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes. Paper presented at 87th Congress of the European-Atherosclerosis-Society (EAS), MAY 26-29, 2019, Maastricht, NETHERLANDS. Atherosclerosis, 287, E228-E228
Open this publication in new window or tab >>Lower HDL, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes
Show others...
2019 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 287, p. E228-E228Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-89263 (URN)10.1016/j.atherosclerosis.2019.06.699 (DOI)000482110800697 ()
Conference
87th Congress of the European-Atherosclerosis-Society (EAS), MAY 26-29, 2019, Maastricht, NETHERLANDS
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2019-09-25Bibliographically approved
Melin, E. O., Thulesius, H., Hillman, M., Svensson, R., Landin-Olsson, M. & Thunander, M. (2019). Lower HDL-cholesterol, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes: a cross sectional study. Lipids in Health and Disease, 18, 1-10, Article ID 65.
Open this publication in new window or tab >>Lower HDL-cholesterol, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes: a cross sectional study
Show others...
2019 (English)In: Lipids in Health and Disease, ISSN 1476-511X, E-ISSN 1476-511X, Vol. 18, p. 1-10, article id 65Article in journal (Refereed) Published
Abstract [en]

Background: Depression, metabolic disturbances and inflammation have been linked to cardiovascular disease and mortality. Low levels of high-density lipoprotein cholesterol (HDL-cholesterol), a known marker of cardiovascular risk, have been observed in patients with major depression in psychiatric populations. Our main aim was to explore associations between depression, antidepressants, and metabolic and inflammatory variables in patients with type 1 diabetes (T1D). A secondary aim was to explore variables associated with HDL-cholesterol. Methods: Cross-sectional design. T1D patients (n = 292, men 55%, age 18-59 years, diabetes duration >= 1 year) were consecutively recruited from one specialist diabetes clinic. Depression was defined as 8 points for Hospital Anxiety and Depression Scale-Depression sub scale. Blood samples, anthropometrics, blood pressure, and data regarding medication and life style were collected from electronic health records. Non-parametric tests, multiple logistic and linear regression analyses were performed. Results: The depression prevalence was 10 and 8% used antidepressants. Median (q(1), q(3)) HDL-cholesterol (mmol/l) was for the depressed 1.3 (1.2, 1.5) and for the non-depressed 1.6 (1.3, 1.8), p = 0.001. HDL-cholesterol levels (per mmol/l) were negatively associated with depression (Adjusted odds ratio (AOR) 0.2, p = 0.007), and the use of antidepressants was positively associated with depression (AOR 8.1, p < 0.001). No other metabolic or inflammatory variables, or life style factors, were associated with depression when adjusted for antidepressants. Abdominal obesity was associated with antidepressants in women (AOR 4.6, p = 0.029). Decreasing HDL-cholesterol levels were associated with increasing triglyceride levels (p < 0.001), increasing high-sensitive C-reactive protein (hs-CRP) levels (p = 0.021), younger age (p < 0.001), male sex (p < 0.001), and depression (p = 0.045). Conclusions: Lower HDL-cholesterol levels, known predictors of cardiovascular disease, were associated with depression in patients with T1D. The use of antidepressants was associated with abdominal obesity in women. Depression, low-grade inflammation measured as hs-CRP, higher triglycerides, male sex, and lower age were independently associated with lower HDL-cholesterol levels.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Type 1 diabetes, Depression, Antidepressants, Serum-lipids, Low-grade inflammation
National Category
Psychology
Research subject
Social Sciences, Psychology; Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-81698 (URN)10.1186/s12944-019-1009-4 (DOI)000461945400002 ()30885233 (PubMedID)2-s2.0-85063129830 (Scopus ID)
Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2019-08-29Bibliographically approved
van der Ploeg, M. A., Streit, S., Achterberg, W. P., Beers, E., Bohnen, A. M., Burman, R. A., . . . Poortvliet, R. K. E. (2019). Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries. Journal of general internal medicine, 34(9), 1751-1757
Open this publication in new window or tab >>Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries
Show others...
2019 (English)In: Journal of general internal medicine, ISSN 0884-8734, E-ISSN 1525-1497, Vol. 34, no 9, p. 1751-1757Article in journal (Refereed) Published
Abstract [en]

Background Statins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners' (GPs) advice to stop statins in oldest-old patients. Objective To investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs' advice to stop statins in oldest-old patients. Design We invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment. Main Measures Cases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (ORadj) were calculated for GPs' advice to stop. Key Results Two thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45-47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89-90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (ORadj 13.8, 95%CI 12.6-15.1), with side effects compared to without ORadj 1.62 (95%CI 1.5-1.7) and with frailty (ORadj 4.1, 95%CI 3.8-4.4) compared to without. Shortened life expectancy increased advice to stop (ORadj 50.7, 95%CI 45.5-56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19-42) to 98% (95% CI 96-99). Conclusions The absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs' advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs' advice to stop statins.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
hydroxymethylglutaryl-CoA reductase inhibitors, cardiovascular diseases, drug therapy, palliative care, general practitioners, clinical decision-making
National Category
Geriatrics
Research subject
Medicine, Gerontology
Identifiers
urn:nbn:se:lnu:diva-89544 (URN)10.1007/s11606-018-4795-x (DOI)000483539200022 ()30652277 (PubMedID)
Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-10-11
Thulesius, H. (2019). Work incentives, chronic illnesses and how sickness certificates are written affect sickness absence.. Scandinavian Journal of Primary Health Care, 37(1), 1-2
Open this publication in new window or tab >>Work incentives, chronic illnesses and how sickness certificates are written affect sickness absence.
2019 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 1, p. 1-2Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Taylor & Francis, 2019
National Category
Other Medical Sciences not elsewhere specified
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-81293 (URN)10.1080/02813432.2019.1571000 (DOI)30784344 (PubMedID)
Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2019-04-15Bibliographically approved
Melin, E. O., Thulesius, H., Hillman, M., Landin-Olsson, M. & Thunander, M. (2018). Abdominal obesity in type 1 diabetes associated with gender, cardiovascular risk factors and complications, and difficulties achieving treatment targets: a cross sectional study at a secondary care diabetes clinic. BMC obesity, 5, 1-10, Article ID 15.
Open this publication in new window or tab >>Abdominal obesity in type 1 diabetes associated with gender, cardiovascular risk factors and complications, and difficulties achieving treatment targets: a cross sectional study at a secondary care diabetes clinic
Show others...
2018 (English)In: BMC obesity, E-ISSN 2052-9538, Vol. 5, p. 1-10, article id 15Article in journal (Refereed) Published
Abstract [en]

Background: Abdominal obesity is linked to cardiovascular diseases in type 1 diabetes (T1D). The primary aim was to explore associations between abdominal obesity and cardiovascular complications, metabolic and inflammatory factors. The secondary aim was to explore whether achieved recommended treatment targets differed between the obese and non-obese participants.

Methods: Cross sectional study of 284 T1D patients (age 18-59 years, men 56%), consecutively recruited from one secondary care specialist diabetes clinic in Sweden. Anthropometrics, blood pressure, serum-lipids and high-sensitivity C-reactive protein (hs-CRP) were collected and supplemented with data from the patients' medical records and from the Swedish National Diabetes Registry. Abdominal obesity was defined as waist circumference men/women (meters): ≥1.02/≥0.88. Hs-CRP was divided into low-, moderate-, and high-risk groups for future cardiovascular events (< 1, 1 to 3, and > 3 to ≤8.9 mg/l). Treatment targets were blood pressure ≤ 130/≤ 80, total cholesterol ≤4.5 mmol/l, LDL: ≤ 2.5 mmol/l, and HbA1c: ≤5 2 mmol/mol (≤ 6.9%). Different explanatory linear, logistic and ordinal regression models were elaborated for the associations, and calibrated and validated for goodness of fit with the data variables.

Results: The prevalence of abdominal obesity was 49/284 (17%), men/women: 8%/29% (P < 0.001). Women (adjusted odds ratio (AOR) 6.5), cardiovascular complications (AOR 5.7), HbA1c > 70 mmol/mol (> 8.6%) (AOR 2.7), systolic blood pressure (per mm Hg) (AOR 1.05), and triglycerides (per mmol/l) (AOR 1.7), were associated with abdominal obesity. Sub analyses (n = 171), showed that abdominal obesity (AOR 5.3) and triglycerides (per mmol/l) (AOR 2.8) were associated with increasing risk levels of hs-CRP. Treatment targets were obtained for fewer patients with abdominal obesity for HbA1c (8% vs 21%, P = 0.044) and systolic blood pressure (51% vs 68%, P = 0.033). No patients with abdominal obesity reached all treatment targets compared to 8% in patients without abdominal obesity.

Conclusions: Significant associations between abdominal obesity and gender, cardiovascular disease, and the cardiovascular risk factors low-grade inflammation, systolic blood pressure, high HbA1c, and triglycerides, were found in 284 T1D patients. Fewer patients with abdominal obesity reached the treatment targets for HbA1c and systolic blood pressure compared to the non-obese.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Abdominal obesity, Cardiovascular complications, Diabetes mellitus type 1, Gender, Glycemic control, Hyperlipidemia, Hypertension, Inflammation, Treatment targets
National Category
Endocrinology and Diabetes
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-81296 (URN)10.1186/s40608-018-0193-5 (DOI)29785272 (PubMedID)
Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2019-04-10Bibliographically approved
Streit, S., Gussekloo, J., Burman, R. A., Collins, C., Kitanovska, B. G., Gintere, S., . . . Poortvliet, R. K. (2018). Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.. Scandinavian Journal of Primary Health Care, 36(1), 89-98
Open this publication in new window or tab >>Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.
Show others...
2018 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 1, p. 89-98Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences.

DESIGN: This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed.

SETTING: GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland.

SUBJECTS: This study included 2543 GPs from 29 countries.

MAIN OUTCOME MEASURES: GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country.

RESULTS: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98).

CONCLUSIONS: GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points  • General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age).  • In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years.  • However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60.  • These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Oldest-old, cardiovascular disease burden, clinical decision-making, hypertension, life expectancy
National Category
Cardiac and Cardiovascular Systems
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-81314 (URN)10.1080/02813432.2018.1426142 (DOI)29366388 (PubMedID)
Available from: 2019-03-25 Created: 2019-03-25 Last updated: 2019-04-12Bibliographically approved
Harris, M., Vedsted, P., Esteva, M., Murchie, P., Aubin-Auger, I., Azuri, J., . . . Taylor, G. (2018). Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion: a European cross-sectional survey.. BMJ Open, 8(9), 1-13, Article ID e022904.
Open this publication in new window or tab >>Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion: a European cross-sectional survey.
Show others...
2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 9, p. 1-13, article id e022904Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Cancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners' (PCPs') referral decisions is lacking.This study analyses health system factors potentially influencing PCPs' referral decision-making when consulting with patients who may have cancer, and how these vary between European countries.

DESIGN: Based on a content-validity consensus, a list of 45 items relating to a PCP's decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs' referral decision-making.

SETTING: A primary care study; 25 participating centres in 20 European countries.

PARTICIPANTS: 1830 PCPs completed the survey. The median response rate for participating centres was 20.7%.

OUTCOME MEASURES: The factors derived from items related to PCPs' referral decision-making. Mean factor scores were produced for each country, allowing comparisons.

RESULTS: Factor analysis identified five underlying factors: PCPs' ability to refer; degree of direct patient access to secondary care; PCPs' perceptions of being under pressure; expectations of PCPs' role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses.

CONCLUSIONS: Five healthcare system factors influencing PCPs' referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
cancer, consultation and referral, decision making, delivery of health care, general practitioners, primary health care
National Category
Cancer and Oncology
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-81295 (URN)10.1136/bmjopen-2018-022904 (DOI)30185577 (PubMedID)
Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2019-04-12Bibliographically approved
Melin, E. O., Svensson, R. & Thulesius, H. (2018). Psychoeducation against depression, anxiety, alexithymia and fibromyalgia: a pilot study in primary care for patients on sick leave. Scandinavian Journal of Primary Health Care, 36(2), 123-133
Open this publication in new window or tab >>Psychoeducation against depression, anxiety, alexithymia and fibromyalgia: a pilot study in primary care for patients on sick leave
2018 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 2, p. 123-133Article in journal (Refereed) Published
Abstract [en]

Objectives: Feasibility testing of a psychoeducational method - The Affect School and Script Analyses (ASSA) - in a Swedish primary care setting. Exploring associations between psychological, and medically unexplained physical symptoms (MUPS). Design: Pilot study. Setting: Three Swedish primary care centers serving 20,000 people. Intervention: 8 weekly 2-hour sessions with a 5-7 participant group led by two instructors - followed by 10 individual hour-long sessions. Subjects: Thirty-six patients, 29 women (81%), on sick-leave due to depression, anxiety, or fibromyalgia. Outcome measures: Feasibility in terms of participation rates and expected improvements of psychological symptoms and MUPS, assessed by self-report instruments pre-, one-week post-, and 18 months post-intervention. Regression coefficients between psychological symptoms and MUPS. Results: The entire 26-hour psychoeducational intervention was completed by 30 patients (83%), and 33 patients (92%) completed the 16-hour Affect School. One-week post-intervention median test score changes were significantly favorable for 27 respondents, with p < .05 after correction for multiple testing for 9 of 11 measures (depression, anxiety, alexithymia, MUPS, general health, self-affirmation, self-love, self-blame, and self-hate); 18 months post intervention the results remained significantly favorable for 15 respondents for 7 of 11 measures (depression, alexithymia, MUPS, general health, self-affirmation, self-love, and self-hate). Conclusions: A psychoeducational method previously untested in primary care for mostly women patients on sick-leave due to depression, anxiety, or fibromyalgia had >80% participation rates, and dear improvements of self-assessed psychological symptoms and MUPS. The ASSA intervention thus showed adequate feasibility in a Swedish primary care setting.

Place, publisher, year, edition, pages
Abingdon-on-Thames: Taylor & Francis, 2018
Keywords
Affective symptoms, alexithymia, anxiety, depression, general practice, medically unexplained physical symptoms, psychotherapy
National Category
Psychology Other Medical Sciences not elsewhere specified
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-76817 (URN)10.1080/02813432.2018.1459225 (DOI)000431601000004 ()29693478 (PubMedID)2-s2.0-85046014270 (Scopus ID)
Available from: 2018-07-11 Created: 2018-07-11 Last updated: 2019-08-29Bibliographically approved
Nicholson, B. D., Goyder, C. R., Bankhead, C. R., Toftegaard, B. S., Rose, P. W., Thulesius, H., . . . Perera, R. (2018). Responsibility for follow-up during the diagnostic process in primary care: a secondary analysis of International Cancer Benchmarking Partnership data.. British Journal of General Practice, 68(670), e323-e332
Open this publication in new window or tab >>Responsibility for follow-up during the diagnostic process in primary care: a secondary analysis of International Cancer Benchmarking Partnership data.
Show others...
2018 (English)In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 68, no 670, p. e323-e332Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained.

AIM: To explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions.

DESIGN AND SETTING: A secondary analysis of survey data from the International Cancer Benchmarking Partnership.

METHOD: The authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK estimates were compared with non-UK ones. Free-text responses were analysed to contextualise quantitative findings using a modified grounded theory approach.

RESULTS: PCPs varied in their retention of responsibility for follow-up from 19% to 97% across jurisdictions and area of follow-up. Test reconciliation was inadequate in most jurisdictions. Significantly fewer UK PCPs retained responsibility for test result communication (73% versus 85%, P = 0.04) and non-attender follow-up (78% versus 93%, P<0.01) compared with non-UK PCPs. PCPs have developed bespoke, inconsistent solutions to follow-up. In cases of greatest concern, 'double safety netting' is described, where both patient and PCP retain responsibility.

CONCLUSION: The degree to which PCPs retain responsibility for follow-up is dependent on their level of concern about the patient and their primary care system's properties. Integrated systems to support follow-up are at present underutilised, and research into their development, uptake, and effectiveness seems warranted.

Place, publisher, year, edition, pages
Royal College of General Practitioners, 2018
Keywords
cancer, diagnosis, diagnostic errors, diagnostic safety, general practice, primary care, safety netting
National Category
Cancer and Oncology
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-81213 (URN)10.3399/bjgp18X695813 (DOI)29686134 (PubMedID)
Available from: 2019-03-21 Created: 2019-03-21 Last updated: 2019-04-12Bibliographically approved
Organisations

Search in DiVA

Show all publications