Abstract

Objective To explore pharmacists’ perceptions of, and
attitudes towards, the early identification and referral of
patients with signs and symptoms indicating potential
diagnosis of head and neck cancer (HNC) in community
pharmacy settings.
Design Qualitative methodology, using constant
comparative analysis to undertake an iterative series of
semistructured interviews. Framework analysis facilitated
the identification of salient themes.
Setting Community pharmacies in Northern England.
Participants 17 community pharmacists.
Results Four salient and inter-related
categories emerged:
(1) Opportunity and access, indicating frequent consultations
with patients presenting with potential HNC symptoms
and the accessible nature of community pharmacists; (2)
Knowledge gap, indicating knowledge of key referral criteria,
but limited experience and expertise in undertaking more
holistic patient assessments to inform clinical decision
making; (3) Referral pathways and workloads; indicating
good working relationships with general medical practices,
but limited collaboration with dental services, and a desire to
engage with formal referral pathways, but current practices
based entirely on signposting resulting in a potential lack of
safety-netting,
no auditable trail, feedback mechanism or
integration into the multidisciplinary team; (4) Utilisation of
clinical decision support tools; indicating that no participants
were aware the Head and Neck Cancer Risk Calculator
(HaNC-RC
V2) for HNC but were positive towards the use of
such tools to improve decision making. HaNC-RC
V2 was
seen as a potential tool to facilitate a more holistic approach
to assessing patient’s symptoms, acting as a prompt to
further explore a patient’s presentation, requiring further
investigation in this context.
Conclusions Community pharmacies offer access to
patients and high-risk
populations that could support HNC
awareness initiatives, earlier identification and referral.
However, further work to develop a sustainable and cost-effective
approach to integrating pharmacists into cancer
referral pathways is needed, alongside appropriate training
for pharmacists to successfully deliver optimum patient
care