CREDIBLE study experience Having gone through a period of us running the searches at your practice, has it changed any aspect of practice? Has it changed referral thresholds? Made you question current practice? Raised awareness of symptoms? Influenced decision making? Changed your view of decision support systems? Do you think it this something that should be done as standard practice in primary care? What the advantages of this kind of case finding? What are the disadvantages? Do the advantages outweigh the disadvantages? What do you think needs to be done to embed this into routine practice? Who would need to do what? Instead of a monthly review of patient records, would you prefer a system that flagged up patients as soon as they met referral criteria?
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CREDIBLE study context: local Where do you put early diagnosis of cancer in your list of priorities? What about your colleagues here — do the other GPs see things differently? Does referring patients for further investigations improve or damage your relationship with them?
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CREDIBLE study context: wider Do you agree with the NICE guidelines on referral? 2-week wait (urgent) referral for investigation of: persistent diarrhoea and/or rectal bleeding (both if aged ≥40 years, either if aged ≥60 years) unexplained iron deficiency anaemia (for investigation of both upper and lower gastrointestinal cancer) rectal mass abnormal rectal exam 'In patients with equivocal symptoms who are not unduly anxious, it is reasonable to use a period of "treat, watch and wait" as a method of management' (Weight loss and abdominal pain are risks but not NICE referral criteria.)
Are there any times when you’ve been uncertain whether or not to refer for urgent investigation? Anaemia seems to be an area with wide variations in practice. What are your preferences for: diagnosis treatment referral
Can you say what a proper GP should do with regard to early diagnosis of colorectal cancer? How does this CREDIBLE approach support or undermine your sense of being a proper GP? Do you ever have difficulties deciding which consultant to refer to? If you are uncertain about diagnosis, is it better to wait and see or to refer to a specialist? Have you ever been criticised by a consultant when you have made a referral? Is it better to risk annoying a specialist or risk missing a chance to diagnose earlier? Is it better to risk worrying a patient or risk missing a chance to diagnose earlier? If a Faecal Occult Blood test (FOBt) is negative does this influence your decision to refer? What would your reaction be if we said we’d found examples of some GPs who decide not to refer patients with symptoms because they have had a negative FOBt? Would you yourself ever decide not to refer a patient with symptoms if a FOBt was negative? (Here reinforce why NICE recommends they should not a) not reliable enough to rule out, b) wastes time getting a FOBt done and lengthens interval time between symptoms and diagnosis) Do you ever use online learning tools? There is a new online learning tool (with CPD accreditation): Suspected lower gastrointestinal tract cancer: when you should refer (http://learning.bmj.com/learning/search-result.html?moduleId=5003316). Would it have helped you assess the lists of our patients we’ve flagged up if we’d been able to point you in its direction before we started the study? How might we best influence other GPs to refer more appropriately?
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