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Background Recent evidence suggests that the first consultation with a general practitioner (GP) for symptoms of depression may be more than just a vehicle for assessment and management planning (as current guidelines imply). Objectives To identify what patients find helpful, or otherwise, in their first consultation for low mood with a GP. Methods A cross-sectional questionnaire and interview study of patients with low mood who had recently consulted their GP, in the North of England. Patients were asked to complete a questionnaire regarding the consultation, and a Patient Health Questionnaire-9 (PHQ-9), within 2 weeks. They were also invited to take part in a face–face interview with a researcher. Both sources of data were subjected to qualitative thematic analysis. Results Thirty-seven questionnaires were returned; 5 interviews took place. The majority of participants felt better after consulting a GP for the first time for low mood. The factors most commonly cited as helpful were "being listened to" and "understanding or empathy from the GP." Others included "admitting the problem," "being reassured of normality," and "being provided with optimism or hope for change." The most commonly reported difficulty was the patients' struggle to express themselves. Patients often felt that GP follow-up was inadequate. Conclusions These results suggest that the therapeutic benefit of the GP consultation is under-recognized in current guidelines. The results of our study will provide crucial information as to how such consultations can be tailored to improve patient satisfaction. [ABSTRACT FROM AUTHOR]

Context: The Covid-19 pandemic and implementation of measures to limit the spread of the virus significantly affected access to healthcare. Routine care in the UK was transformed; remote consultation was introduced for some services while others were disbanded. Public health messaging encouraged the public to stay at home to protect the NHS. Our study investigating the healthcare experience of people living with multimorbidity (presence of >2 long term conditions) including Rheumatoid Arthritis (RA) and persistent musculoskeletal (MSK) pain, was suspended because of the pandemic. Objective: To investigate the experiences of people living with RA or MSK pain during the pandemic. Study design and analysis: Semi-structured interviews were conducted with 47 people living with RA or persistent MSK pain, with and without multimorbidity. Data were analysed thematically, and findings mapped to the 'candidacy' theoretical framework. Setting and dataset: Participants were recruited from outpatient rheumatology clinics, pain clinics and primary care, in Scotland, UK. Participants were mostly female (31 female, 16 male) and aged between 24 and 92 years. Results: Our analysis identified themes related to: (1) Healthcare system impacts (remote consultations, delays and cancellations, difficulties accessing care, Covid information) and (2) Impacts on individuals (social and emotional wellbeing, pain and mobility, mental health, care seeking behaviour, employment/finance, understandings of Covid). Themes were mapped to the processes of candidacy. It was clear that the move towards remote consultations may have unintended consequences and should not be 'one-size fits all'. Conclusions: Our findings highlight experiences of people with RA/persistent MSK pain and multimorbidity during the Covid-19 pandemic. The health seeking behaviour of some patients has changed, and it is unclear if this will continue in the longer term. These findings support the need for discussion around the longer-term impact of the pandemic on individuals and changes within the healthcare system., Presenters Sara Macdonald, PhD, Susan Browne, PhD, MA, MPhil, Karen Wood, MA, Frances Mair, MD, FRCGP, Barbara Nicholl, PhD, [...]

Context: Burden of Treatment Theory (BOTT) proposes poorer outcomes when the work of managing illness (treatment burden) outweighs an individual's capacity. Treatment burden is greater for people experiencing multimorbidity, particularly when living in areas of high socioeconomic deprivation (SED), where factors that reduce capacity (e.g. car access) also cluster. It is likely community factors (e.g. local assets) can enhance, or diminish individual capacity, but how these factors interact is unclear. Objective Explore how individual and community factors influence self-management of multimorbidity in the context of high SED. Study Design: 30 Qualitative semi-structured interviews, analysed thematically. Setting/ Population: Individuals with >3 chronic conditions from a community experiencing high SED. Intervention: N/A Outcome Measures: N/A Results: Four key themes: biographical disruption as a catalyst--many successfully implemented lifestyle changes, almost all triggered by a diagnosis, most would not have made changes otherwise; 'being known': many described 'being known' in the community, creating security. However, there was also stigma of 'being known' from their area, experienced in multiple spheres, influencing experience of wider systems. 'Fear of failure' where attempts to make changes failed, it often resulted in fatalism, linked to experience of wider stigma. For these participants it was easier to not change, even if less than ideal, than risk failing/ being judged, again; Holistic care: people valued care where they were 'seen as a person', but experience was often biomedically focused. Interviewees recognised wider structural issues in the health service inhibiting this type of care eg. lack of time. For some reduced agency, particularly unwillingness to challenge staff, were key issues. Conversely, where people felt empowered to make decisions, that adapted to their context/values, this was generally in the context of strong relationships with primary care providers. Conclusion Capacity factors are important but rarely acknowledged, or addressed, by practitioners or health systems. The influence of social stigma on access/treatment decisions needs considered in health system delivery. Future research should explore interventions to empower people, particularly those experiencing stigma in their wider community. The biographical disruption of an illness should also be viewed as an opportunity for health promotion messages, Presenters Marianne McCallum, BMed, MBChB, MSc, MRCGP, Frances Mair, MD, FRCGP, Sara Macdonald, [...]

Objectives: Pre-trial focus groups of the Early detection of Cancer of the Lung Scotland (ECLS) trial indicated that those at high risk of lung cancer are more likely to engage with community-based recruitment methods. The current study aimed to understand if general practitioner (GP) and community-based recruitment might attract different groups of people, and to quantitatively explore the demographic and psychosocial differences between people responding to GP or community-based recruitment. Design: Secondary data analysis of ECLS trial baseline data. Methods: Adults (n = 11,164) aged 50 to 75 years completed a baseline questionnaire as part of their participation in the ECLS trial. The questionnaire assessed smoking behaviour, health state, health anxiety and illness perception. Alongside demographic characteristics, how participants were made aware of the study/participant recruitment method (GP recruitment/community recruitment) was also obtained via trial records. Results: The likelihood of being recruited via community-based methods increased as deprivation level decreased. Those recruited via the community had higher levels of perceived personal control of developing lung cancer and were more likely to understand their own risk of developing lung cancer, compared to those who were recruited to the trial via their GP. Health state and health anxiety did not predict recruitment methods in multivariable analysis. Conclusions: Community and opportunistic screening invitations were associated with uptake in people from less-deprived backgrounds, and therefore might not be the optimal method to reach those at high risk of lung cancer and living in more deprived areas. [ABSTRACT FROM AUTHOR]

In Oedipus at Colonus Sophocles shows that neither individual reason nor piety are singularly sufficient for either individual happiness or the common good. Human understanding is dependent on a decentering of the individual, such that the reason of the wider community, including that of the gods, can augment the limitations of individual perspective. Sophocles shows not only the dependence of faith and reason on one another, but the degree to which both are dependent on reciprocal good will within a community. [ABSTRACT FROM AUTHOR]

Simple Summary: People living in rural areas are less likely to survive cancer than those living in urban areas. There is evidence suggesting that poorer survival amongst rural cancer patients may be because these patients take longer to be diagnosed, particularly in the time between their symptoms beginning and them going to hospital to see a specialist. This study explored the experiences of people with symptoms of bowel cancer, in rural Northern England, to examine whether there were any common causes of 'delay' for these patients. Participants reported that their health beliefs and self-reliance, concerns about losing time at work, and having a poor relationship with their GP, could all influence whether they consulted the GP early about their symptoms. Having identified these unique barriers for rural patients, in relation to seeing the GP about bowel symptoms, we can develop ways to support earlier consultations with GPs, to improve the outcomes of rural patients who develop cancer. Rural cancer inequalities are evident internationally, with rural cancer patients 5% less likely to survive than their urban counterparts. There is evidence to suggest that diagnostic delays prior to entry into secondary care may be contributing to these poorer rural cancer outcomes. This study explores the symptom appraisal and help-seeking decision-making of people experiencing symptoms of colorectal cancer in rural areas of England. Patients were randomly invited from 4 rural practices, serving diverse communities. Semi-structured interviews were undertaken with 40 people who had experienced symptoms of colorectal cancer in the preceding 8 weeks. Four key themes were identified as influential in participants' willingness and timeliness of consultation: a desire to rule out cancer (facilitator of help-seeking); stoicism and self-reliance (barrier to help-seeking); time scarcity (barrier to help-seeking); and GP/patient relationship (barrier or facilitator, depending on perceived strength of the relationship). Self-employed, and "native" rural residents most commonly reported experiencing time scarcity and poor GP/patient relationships as a barrier to (re-)consultation. Targeted, active safety-netting approaches, and increased continuity of care, may be particularly beneficial to expedite timely diagnoses and minimise cancer inequalities for rural populations. [ABSTRACT FROM AUTHOR]