Casnet2: Evaluation of electronic safety netting for suspected cancer

The CASNET2 study tests an electronic safety-netting toolkit that provides primary care staff with a way to record safety-netting advice and actions when they think cancer could be causing the patient’s symptoms, and to set reminders to ensure that the patient is followed-up. The study will measure the impact the toolkit has on the outcomes of patients that are safety-netted using the tool, what it is like to use the tool, and whether any improvements can be made.

Background

Safety-netting is very common in primary care and refers to a set of actions that aim to ensure that a patient either reattends promptly if they need to, or is followed-up by one of the primary care team. This is to try to reduce any delays in diagnosing serious diseases like cancer as much as possible and it is used when there is uncertainty in what is causing the patient’s symptoms or how the symptoms might progress. Safety-netting involves both advice given to the patient during their appointment, for example on what concerning symptoms they should look out for, and a range of actions done by the primary care team after the appointment. The safety-netting actions taken on by the primary care team include things like checking a patient was seen at their specialist appointment, that the results of a test have been returned and communicated to the patient, or, if no tests were ordered yet, whether their symptoms have improved or need to be investigated further.

Currently, the way safety-netting is done is through a mix of methods that can include verbal or written advice to the patient, GPs keeping personal diary reminders, notes on the patient’s electronic health record, or reminder systems set up by the practice. This means that safety-netting is often done inconsistently and increases the risk that seriously ill patients will fall through the net.

WHAT WE ARE DOING

The CASNET2 toolkit was provided to primary care practices across England to test. These practices provided data on how GPs used the toolkit when they suspected cancer and what happened to the patients who were safety-netted using the toolkit. This testing phase of the study is now complete and we will compare the outcomes of patients before and after the toolkit was introduced to see if there was any impact on the outcomes of these patients.

We also carried out some interviews with primary care staff. These interviews covered:

- How safety-netting is done in their practice when there is a suspicion of cancer.

- How COVID-19 affected the suspicion of cancer in their practice.

- How they found using the CASNET2 toolkit and how it could be improved (with those who had tested it).

- What features they would like to see in a safety-netting tool.

Finally we took the features that the primary care staff told us were important for a safety-netting tool to have and presented them to another group of staff who prioritised the features in a Delphi study. A Delphi study involves showing a group of experts a range of options to solve a problem or answer a question and the options are discussed and voted on until agreement is reached on what best or most important options are. We have turned the high priority features into recommendations on what features are important and should be included in any future attempt to design an electronic safety-netting tool.

Expected Impact

The CASNET2 toolkit will remain available to GP practices after the study is complete. Changes may be made to it based on our findings to improve the user experience. If we find that the outcomes of patients who were safety-netted using the toolkit were improved, we will use this to make a case for its use.