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ABSTRACT: Background
A promising approach to manage clinical uncertainty and thereby reduce the risk of preventable diagnostic harm is to use safety-netting advice (ie, communicating structured information to patients about when and where to reconsult healthcare).Aim
To explore clinicians' and patients' views on when and how safety-netting can be successfully applied in primary-care and emergency-care settings.Design and setting
An exploratory qualitative research design; we performed focus groups and interviews in a Swedish setting.Participants
Nine physicians working in primary or emergency care and eight patients or caregivers participated. The participants were an ethnically homogeneous group, originating from Western European or Australian backgrounds.Method
Data were analysed inductively, using the framework method. The results are reported according to the Standards for Reporting Qualitative Research guidelines for reporting qualitative research.Results
In order to manage diagnostic uncertainty using safety-netting, clinicians and patients emphasised the need to understand the preconditions for the consultation (ie, the healthcare setting, the patient's capacity and existing power imbalance). Furthermore, participants raised the importance of establishing a mutual understanding regarding the patient's perspective and the severity of the situation before engaging in safety-netting advice.Conclusion
The establishment of a shared mental model between clinician and patient of the preconditions for the clinical encounter is a vital factor affecting how safety-netting advice is communicated and received and its ability to support patients in problem detection and planning after the visit. We suggest that successful safety-netting can be viewed as a team activity, where the clinician and patient collaborate in monitoring how the patient's condition progresses after the care visit. Furthermore, our findings suggest that to be successfully implemented, safety-netting advice needs to be tailored to the clinical context in general and to the patient-clinician encounter in particular.
SUBMITTER: Fernholm R
PROVIDER: S-EPMC10565180 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
Fernholm Rita R Wannheden Carolina C Trygg Lycke Sofia S Riggare Sara S Pukk Harenstam Karin K
BMJ open 20231005 10
<h4>Background</h4>A promising approach to manage clinical uncertainty and thereby reduce the risk of preventable diagnostic harm is to use safety-netting advice (ie, communicating structured information to patients about when and where to reconsult healthcare).<h4>Aim</h4>To explore clinicians' and patients' views on when and how safety-netting can be successfully applied in primary-care and emergency-care settings.<h4>Design and setting</h4>An exploratory qualitative research design; we perfor ...[more]