Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
BMJ Open. 2023 Mar 7;13(3):e068607. doi: 10.1136/bmjopen-2022-068607.
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.
Qualitative methodology, using constant comparative analysis to undertake an iterative series of semistructured interviews. Framework analysis facilitated the identification of salient themes.
Community pharmacies in Northern England.
17 community pharmacists.
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.
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.
探讨药剂师对社区药房环境中具有潜在头颈部癌症（HNC）诊断迹象和症状的患者进行早期识别和转介的看法和态度。
定性方法，使用恒定比较分析进行迭代系列半结构化访谈。框架分析有助于确定突出的主题。
英格兰北部的社区药房。
17 名社区药剂师。
出现了四个突出且相互关联的类别：（1）机会和可及性，表明经常与出现潜在 HNC 症状的患者进行咨询，以及社区药剂师的可及性；（2）知识差距，表明对关键转介标准有一定的了解，但在进行更全面的患者评估以告知临床决策方面经验和专业知识有限；（3）转介途径和工作量，表明与一般医疗实践有良好的工作关系，但与牙科服务的合作有限，渴望参与正式的转介途径，但目前的做法完全基于指示，可能缺乏安全网、无可审核的轨迹、反馈机制或纳入多学科团队；（4）临床决策支持工具的利用，表明没有参与者意识到用于 HNC 的头颈部癌症风险计算器（HaNC-RC V2），但对使用此类工具来改善决策持积极态度。HaNC-RC V2 被视为一种潜在的工具，可以更全面地评估患者的症状，作为进一步探讨患者表现的提示，在这种情况下需要进一步调查。
社区药房为患者和高危人群提供了接触机会，可以支持 HNC 意识倡议，更早地识别和转介。然而，需要进一步努力制定一种可持续且具有成本效益的方法，将药剂师纳入癌症转介途径，同时为药剂师提供适当的培训，以提供最佳的患者护理。
