Recommendations on patient support, safety netting and the diagnostic process

Recommendations on patient support, safety netting and the diagnostic process

The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop the guidance.

The wording used in the recommendations in this guideline (for example, words such as 'offer' and 'consider') denotes the certainty with which the recommendation is made (the strength of the recommendation). See about this guideline for details.

The recommendations in this guideline have been organised into 3 separate sections to help healthcare professionals find the relevant information easily. This section includes the recommendations on patient support, safety netting and the diagnostic process. There are also sections covering the recommendations for investigation and referral organised by the site of the suspected cancer and organised by symptoms and investigation findings.

1.14 Patient information and support

1.14.1 Discuss with people with suspected cancer (and their carers as appropriate, taking account of the need for confidentiality) their preferences for being involved in decision‑making about referral options and further investigations including their potential risks and benefits. [2015]

1.14.2 When cancer is suspected in a child, discuss the referral decision and information to be given to the child with the parents or carers (and the child if appropriate). [2015]

1.14.3 Explain to people who are being referred with suspected cancer that they are being referred to a cancer service. Reassure them, as appropriate, that most people referred will not have a diagnosis of cancer, and discuss alternative diagnoses with them. [2015]

1.14.4 Give the person information on the possible diagnosis (both benign and malignant) in accordance with their wishes for information (see also the NICE guideline on patient experience in adult NHS services). [2015]

1.14.5 The information given to people with suspected cancer and their families and/or carers should cover, among other issues:

  • where the person is being referred to

  • how long they will have to wait for the appointment

  • how to obtain further information about the type of cancer suspected or help before the specialist appointment

  • what to expect from the service the person will be attending

  • what type of tests may be carried out, and what will happen during diagnostic procedures

  • how long it will take to get a diagnosis or test results

  • whether they can take someone with them to the appointment

  • who to contact if they do not receive confirmation of an appointment

  • other sources of support. [new 2015]

1.14.6 Provide information that is appropriate for the person in terms of language, ability and culture, recognising the potential for different cultural meanings associated with the possibility of cancer. [2015]

1.14.7 Have information available in a variety of formats on both local and national sources of information and support for people who are being referred with suspected cancer. For more information on information sharing, see section 1.5 in the NICE guideline on patient experience in adult NHS services. [new 2015]

1.14.8 Reassure people in the safety netting group (see recommendation 1.15.2) who are concerned that they may have cancer that with their current symptoms their risk of having cancer is low. [new 2015]

1.14.9 Explain to people who are being offered safety netting (see recommendation 1.15.2) which symptoms to look out for and when they should return for re‑evaluation. It may be appropriate to provide written information. [new 2015]

1.14.10 When referring a person with suspected cancer to a specialist service, assess their need for continuing support while waiting for their referral appointment. This should include inviting the person to contact their healthcare professional again if they have more concerns or questions before they see a specialist. [2005]

1.14.11 If the person has additional support needs because of their personal circumstances, inform the specialist (with the person's agreement). [2005]

1.15 Safety netting

1.15.1 Ensure that the results of investigations are reviewed and acted upon appropriately, with the healthcare professional who ordered the investigation taking or explicitly passing on responsibility for this. Be aware of the possibility of false‑negative results for chest X‑rays and tests for occult blood in faeces. [new 2015]

1.15.2 Consider a review for people with any symptom that is associated with an increased risk of cancer, but who do not meet the criteria for referral or other investigative action. The review may be:

  • planned within a time frame agreed with the person or

  • patient‑initiated if new symptoms develop, the person continues to be concerned, or their symptoms recur, persist or worsen. [new 2015]

1.16 The diagnostic process

1.16.1 Take part in continuing education, peer review and other activities to improve and maintain clinical consulting, reasoning and diagnostic skills, in order to identify at an early stage people who may have cancer, and to communicate the possibility of cancer to the person. [2005]

1.16.2 Discussion with a specialist (for example, by telephone or email) should be considered if there is uncertainty about the interpretation of symptoms and signs, and whether a referral is needed. This may also enable the primary healthcare professional to communicate their concerns and a sense of urgency to secondary healthcare professionals when symptoms are not classical. [2005]

1.16.3 Put in place local arrangements to ensure that letters about non-urgent referrals are assessed by the specialist, so that the person can be seen more urgently if necessary. [2005]

1.16.4 Put in place local arrangements to ensure that there is a maximum waiting period for non‑urgent referrals, in accordance with national targets and local arrangements. [2005]

1.16.5 Ensure local arrangements are in place to identify people who miss their appointments so that they can be followed up. [2005]

1.16.6 Include all appropriate information in referral correspondence, including whether the referral is urgent or non‑urgent. [2005]

1.16.7 Use local referral proformas if these are in use. [2005]

1.16.8 Once the decision to refer has been made, make sure that the referral is made within 1 working day. [2005]

  • National Institute for Health and Care Excellence (NICE)