A feasibility study of the Shared Safety Net Action Plan (SSNAP): a safety-netting intervention that engages patients to support earlier diagnosis of cancer in general practice
A template embedded in GP computer systems gives patients a written plan for monitoring vague symptoms like fatigue or nausea that could signal cancer. This matters because the UK has some of the worst cancer survival rates in Western Europe, and delays in diagnosis are a major cause. Current safety-netting—advising patients to watch for worsening symptoms—tends to be passive, missing chances to catch cancer early. The Shared Safety Net Action Plan (SSNAP) is designed to change that by making patients active partners in their own monitoring. If SSNAP proves feasible and acceptable, it could shift how general practices handle non-specific symptoms. Patients would know exactly what to look for, how long to watch, and when to come back. Staff would have clearer criteria for re-attendance. The ultimate goal is to catch more cancers at earlier stages, improving survival rates without requiring new equipment or expensive tests. This study tests SSNAP in six general practices in Northern England, gathering feedback from patients and staff. If the approach works, the next step is a larger trial to see whether it can be rolled out more widely.
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Background: The UK and Ireland have the worst cancer survival rates in Western Europe, with delays in diagnosis a major cause. Safety-netting – advising patients on how to actively monitor their symptoms – can help diagnose cancers more quickly but existing approaches tend to be passive in nature, missing opportunities to engage patients. As patients are likely to first report symptoms in general practice, safety-netting is especially important here. The Shared Safety Net Action Plan (SSNAP) is designed to involve patients fully in safety-netting when they see their healthcare professional about non-specific symptoms such as fatigue or nausea that could be a sign of cancer. It provides a template in the general practice electronic patient record, SystmOne, which guides patients and professionals in their discussions. Outcomes are then summarised in patient texts, emails or on a paper form, so that everyone understands what symptoms patients need to monitor, for how long, and in what circumstances they should re-consult. These effects are modelled in a logic model and programme theory. Aims: To assess SSNAP s feasibility and acceptability to support earlier diagnosis of cancer in general practice, using this information to inform the design of a subsequent cluster RCT. Methods: This feasibility study will involve six general practices in Northern England serving different populations. One hundred and twenty adult patients will be recruited (60 per arm). Practices will be randomised, with intervention practices using SSNAP with eligible patients and control practices indicating whether they would have used it. Patients and families will complete satisfaction questionnaires and those in the intervention arm will be interviewed about SSNAP. Staff will take part in interviews and focus groups. Descriptive statistics will be produced which summarise SSNAP s use. Qualitative data will be analysed thematically, focusing on acceptability and feasibility. These data will be used to refine the logic model and programme theory and inform the design of a cluster RCT to test SSNAP more widely. Timelines for delivery: Key milestones include: WP1: practices recruited, randomised, trained and baseline statistics collected (by month 6); WP2: SSNAP delivered in intervention practices, patient questionnaires undertaken, updated statistics collected (by month 15); WP3: participant interviews and focus groups completed, quantitative and qualitative data analysed, trial protocol finalised (by month 30). Anticipated Impact and Dissemination: Outputs will include: paper and digital versions of SSNAP; a refined logic model and programme theory; trial protocol; implementation guide and training tools. Guided by our PPIE group, findings will be shared accessibly with the general practice workforce and interested groups such as cancer charities and patient/community groups. Anticipated impacts include changing patient and staff behaviour for closer monitoring of possible non-specific cancer symptoms and increasing awareness of symptom monitoring; supporting appropriate re-attendance in general practice by clarifying criteria for re-attendance; and becoming an effective component in non-specific symptoms pathways into secondary care. Ultimately, we anticipate SSNAP will increase cancer diagnoses at earlier stages in general practice, thereby improving cancer survival rates
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