Black Georgia B, Nicholson Brian D, Moreland Julie-Ann, Fulop Naomi J, Lyratzopoulos Georgios, Baxter Ruth
Wolfson Institute of Population Health, Queen Mary University of London, London, UK
Applied Health Research, University College London Research Department of Epidemiology and Public Health, London, UK.
BMJ Qual Saf. 2025 Jun 19;34(7):457-468. doi: 10.1136/bmjqs-2024-017749.
Over the past two decades, the UK has actively developed policies to enhance early cancer diagnosis, particularly for individuals with non-specific cancer symptoms. Non-specific symptom (NSS) pathways were piloted and then implemented in 2015 to address delays in referral and diagnosis. The aim of this study was to outline the functions that enable NSS teams to investigate cancer and other diagnoses for patients with NSSs.
The analysis was derived from a multisite ethnographic study conducted between 2020 and 2023 across four major National Health Service (NHS) trusts. Data collection encompassed observations, patient shadowing, interviews with clinicians and patients (n=54) and gathered documents. We used principles of the functional resonance analysis method to identify the functions of the NSS pathway and analyse their relevance to patient safety.
Our analysis produced 29 distinct functions within NSS pathways, organised into two clusters: pretesting assessment and information gathering, and post-testing interpretation and management. Safety-critical functions encompassed assessing the reason for referral, deciding on a plan of investigation and estimating the remaining cancer risk. We also identified ways that teams build and maintain safety across all functions, for example, by cultivating generalist-specialist expertise within the team and creating continuity through patient navigation. Variation in practice across sites revealed targets for an NSS pathway blueprint that would foster local development and quality improvement.
Our findings suggest that national and local improvement plans could differentiate specific policies to reduce unwarranted variation and support adaptive variation that facilitates the delivery of safe care within the local context. Enhancing multidisciplinary teams with additional consultants and deploying patient navigators with clinical backgrounds could improve safety within NSS pathways. Future research should investigate different models of generalist-specialist team composition.
在过去二十年中，英国积极制定政策以加强早期癌症诊断，尤其是针对有非特异性癌症症状的个体。非特异性症状（NSS）路径进行了试点，然后于2015年实施，以解决转诊和诊断延迟的问题。本研究的目的是概述使NSS团队能够为有NSS的患者调查癌症和其他诊断的功能。
该分析源自2020年至2023年在四个主要的国民保健服务（NHS）信托机构进行的多地点人种学研究。数据收集包括观察、患者跟踪、对临床医生和患者的访谈（n = 54）以及收集文件。我们使用功能共振分析方法的原则来确定NSS路径的功能，并分析它们与患者安全的相关性。
我们的分析在NSS路径中产生了29种不同的功能，分为两类：检测前评估和信息收集，以及检测后解释和管理。关键安全功能包括评估转诊原因、确定调查计划以及估计剩余癌症风险。我们还确定了团队在所有功能中建立和维护安全的方式，例如，通过在团队中培养通科-专科专业知识以及通过患者导航创造连续性。各地点实践的差异揭示了NSS路径蓝图的目标，该蓝图将促进地方发展和质量改进。
我们的研究结果表明，国家和地方改进计划可以区分具体政策，以减少不必要的差异，并支持适应性差异，从而在当地背景下促进安全护理的提供。增加顾问以加强多学科团队并部署具有临床背景的患者导航员可以提高NSS路径中的安全性。未来的研究应调查通科-专科团队组成的不同模式。
