The feasibility and acceptability of using text-messages to safety-net patients with low risk cancer symptoms in GP primary care


Session type:

Yasemin Hirst1,Anita Lim2
1UCL,2Queen Mary University of London



Safety-netting is an important diagnostic strategy for managing potential cancer symptoms and promoting early diagnosis. Currently, GPs rely on a variety of (mostly manual) processes to manage and implement safety-netting, such as asking patients to return if symptoms persist. However, this relies on patients to reassess their symptoms and to be proactive. Text messages could be an effective yet simple way to semi-automate safety-netting in patients with low-risk cancer symptoms, and provide a nudge to come back (“Txt-Netting”). This study aimed to investigate the feasibility and acceptability of safety-netting using text messages among GPs. 


London GPs were invited to take part in the study through Clinical Commissioning Groups and existing liaisons. Focus groups were arranged based on GP availability with a minimum two and maximum of six GPs per group. A total of 15 GPs took part either in one of the four focus group discussions (n=13) or had a telephone interview (n=2). Focus groups were audio-recorded and transcribed verbatim. Data were analysed using Thematic Analysis (Braun & Clarke, 2006).


GPs were highly enthusiastic about Txt-Netting, particularly when mmediate referral or investigation is not warranted (i.e. without red flag symptoms or symptom clusters). With many GPs using personal diaries to chase patients, text messages were perceived as cost and time efficient. GPs suggested that Txt-Netting could be a valuable tool to encourage timely review of symptom(s) and signpost to information to improve symptom awareness. A further suggested use was to confirm attendance at two-week wait referrals for suspected cancer. However, concerns were raised about mobile phone record coverage, workload, confidentiality and the lack of available appointments.


The use of text messages is an acceptable method to safety-net patients with low-risk cancer symptoms in GP primary care. Further work is needed to explore how this would best be implemented in practice.