Stakeholders’ views of recurrent sore throat, tonsillitis and their management: a qualitative interview study for the NAtional Trial of Tonsillectomy IN Adults (NATTINA Part 1)

Abstract

ObjectivesTo determine the impact of recurrent sore throats and tonsillitis in adults and stakeholder views of treatment pathways. DesignQualitative semi-structured interview design reporting novel data from a feasibility study for a UK national trial of tonsillectomy in adults.

Is Scottish Intercollegiate Guidelines Network guidance for GP management of tonsillitis suitable? A qualitative study

“…Previous qualitative work highlights the issue of tonsillectomy being classed as a procedure of 'limited clinical value' and of NHS practice boards encouraging GPs to reduce referral rates for such procedures 2 . Moreover, perhaps due to this pressure, GPs are required to follow a rigorous vetting process in the form of local and national guidelines for the treatment of recurrent sore throat.…”

“…As part of the NAtional Trial of Tonsillectomy IN Adults (NATTINA) feasibility study 2,18 and the main NATTINA trial process evaluation 19 , GPs were interviewed on their views of the sore throat patient pathway process and treatment as well as of the NATTINA trial.…”

“…Patients' experiences of recurrent sore throats impinge significantly on lifestyle through incapacitating physical symptoms and impact on work, family and social life 2 . Excessive absences from work can, in turn, effect productivity, promotion status and even employability 3 .…”

Is tonsillectomy recommended in adults with recurrent tonsillitis?

“…Recent qualitative work demonstrates that general practitioners feel pressured to reduce tonsillectomy referral rates and that many patients perceive a barrier to the treatment they desire. 10 New UK guidelines from the Royal College of Surgeons of England for adult tonsillectomy were published in 2016 13 but are essentially unchanged since the 2010 Scottish Intercollegiate Guidelines Network guidelines, as no further evidence is available (box 1). The referral guideline for surgery on the basis of the frequency and duration of recurrent sore throats only extrapolates from childhood evidence, and evidence is needed on clinical and cost effectiveness in adults.…”

‘Thinking that somebody's going to delay [a tonsillectomy] for one to two years is quite horrifying really’: a qualitative feasibility study for the NAtional Trial of Tonsillectomy IN Adults (NATTINA Part 2)

“…The NAtional Trial of Tonsillectomy IN Adults (NATTINA) consists of this feasibility study, an internal pilot and definitive trial of 600 adults, with embedded qualitative process evaluation . This paper, reporting the main findings from the feasibility study, follows a linked paper where stakeholders were asked their views of recurrent sore throat, tonsillitis and their management as part of this feasibility study. Gaining stakeholder perspectives of these issues was considered to be an essential part of the study; however, the depth of findings allowed for two linked, but discrete papers to be completed.…”