Using the candidacy framework to understand how doctor-patient interactions influence perceived eligibility to seek help for cancer alarm symptoms: a qualitative interview study

Tookey, Sara; Renzi, Cristina; Waller, Jo; Wagner, Christian von; Whitaker, Katriina L.

doi:10.1186/s12913-018-3730-5

Cited by 20 publications

(36 citation statements)

References 33 publications

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“…to keep appointments), service users do not have flexibility to accommodate their candidacy to fit restricted schedules. Our work shows that in addition to referrals [28] and appointment and booking systems [31,45], service flexibility also represents an important feature of permeability.…”

Section: Discussionmentioning

confidence: 95%

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A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia

Poli

Oyebode

Airoldi

et al. 2020

BMC Health Serv Res

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Background: Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction. Methods: Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories. Results: The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users' resistance to offers, users' appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need. Conclusion: The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements.

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Section: Discussionmentioning

confidence: 95%

“…Hence, this expands the possible determinants of appearance, beyond users’ socio-economic characteristics [ 21 ], their conceptualisation of illness identity [ 28 ] and their awareness or perception of organisational constraints within which care is provided (e.g. time restriction within consultations) [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia

Poli

Oyebode

Airoldi

et al. 2020

BMC Health Serv Res

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“…The conceptual framework of Candidacy was chosen to systematically explore and identify the factors associated with access to TKR 9. Rather than focusing on utilisation as a proxy for healthcare access, Candidacy emphasises the complex and contingent nature of healthcare access and has been applied to understand different stages of a patients’ healthcare journey by incorporating psychosocial factors which may influence decision-making 10–12. The Candidacy framework consists of seven domains: Identification of Candidacy, Navigation, Permeability of services, Appearances at health services, Adjudications, Offers and resistance, and Operating conditions and the local production of Candidacy (see definitions online supplementary Appendix 1).…”

Section: Design and Frameworkmentioning

confidence: 99%

What are the patient factors that impact on decisions to progress to total knee replacement? A qualitative study involving patients with knee osteoarthritis

et al. 2019

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ObjectivesGeneral practitioners (GPs) are often the first health professionals to assess patients with osteoarthritis (OA). Despite clinical guideline recommendations for non-surgical intervention as first-line therapies, the most frequent referral from a GP for a person with knee OA is to an orthopaedic surgeon. The aim of our study was to explore patient factors that impact on the decision to progress to total knee replacement (TKR), including the experience of patients in general practice, their perceptions of their condition, and their access and use of community-based allied health interventions.DesignQualitative investigation using semi-structured interviews. The Candidacy framework was selected as a lens to examine the factors driving healthcare access. Data were analysed using a thematic analysis approach. Codes identified in the data were mapped to the seven Candidacy domains. Themes corresponding to each domain were described.SettingA public hospital in Melbourne, Australia.Participants27 patients with knee OA who were on a waiting list to undergo TKR.ResultsTen themes described factors influencing access and use of non-surgical interventions and decision-making for undergoing TKR: (1) History of knee problems, change in symptoms; (2) Physical and psychosocial functioning (Identification of Candidacy); (3) GP and social networks as information sources, access to care (Navigation); (4) Referral pathways (Permeability of services); (5) Communication of impact (Appearances at health services); (6) GP-Surgeon as the predominant referral pathway (Adjudications); (7) Physical activity as painful; (8) Beliefs about effectiveness of non-surgical interventions (Offers and resistance); (9) Familiarity with local system; and (10) Availability (Operating conditions and local production of Candidacy).ConclusionsUsing the Candidacy framework to analyse patients’ experiences when deciding to progress to TKR highlighted missed opportunities in general practice to orient patients to first try non-surgical interventions. Patients with knee OA also require improved support to navigate allied health services.

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“…A growing qualitative evidence-base shows that doctor-patient interactions can influence patients’ perceived eligibility/desire for accessing/reaccessing healthcare,28–30 but this has focused on asking patients about their experiences of accessing healthcare and has not included healthcare professional views. Patient disengagement (eg, adherence to management plans)31 is one of the only patient behaviours highlighted as a potential reason for diagnostic error in primary care 32.…”

Section: Introductionmentioning

confidence: 99%

Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study

et al. 2019

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BackgroundMost cancers are diagnosed following contact with primary care. Patients diagnosed with cancer often see their doctor multiple times with potentially relevant symptoms before being referred to see a specialist, suggesting missed opportunities during doctor-patient conversations.ObjectiveTo understand doctor-patient communication around the significance of persistent or new presenting problems and its potential impact on timely cancer diagnosis.Research designQualitative thematic analysis based on video recordings of doctor-patient consultations in primary care and follow-up interviews with patients and doctors. 80 video observations, 20 patient interviews and 7 doctor interviews across 7 general practices in England.ResultsWe found that timeliness of diagnosis may be adversely affected if doctors and patients do not come to an agreement about the presenting problem’s significance. ‘Disagreements’ may involve misaligned cognitive factors such as differences in medical knowledge between doctor and patient or misaligned emotional factors such as patients’ unexpressed fear of diagnostic procedures. Interviews suggested that conversations where the difference in views is either not recognised or stays unresolved may lead to unhelpful patient behaviour after the consultation (eg, non-attendance at specialist appointments), creating potential for diagnostic delay and patient harm.ConclusionsOur findings highlight how doctor-patient consultations can impact timely diagnosis when patients present with persistent or new problems. Misalignments were common and could go unnoticed, leaving gaps for potential to cause patient harm. These findings have implications for timely diagnosis of cancer and other serious disease because they highlight the complexity and fluidity of the consultation and the subsequent impact on the diagnostic process.

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Using the candidacy framework to understand how doctor-patient interactions influence perceived eligibility to seek help for cancer alarm symptoms: a qualitative interview study

Cited by 20 publications

References 33 publications

A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia

A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia

What are the patient factors that impact on decisions to progress to total knee replacement? A qualitative study involving patients with knee osteoarthritis

Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study

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