Table 2

Recommendations for practice and illustrative links to established consultation models

Recommendations for clinicians using safety-netting*†Stages of consultation models relating to recommendation
Pendleton et al 150 Calgary-Cambridge151 Neighbour’s checkpoints6
1. Consider providing safety-netting advice to all patients where there is uncertainty in the diagnosis or the potential for the diagnosis to evolve.---
2. Offer safety-netting advice in simple terms and tailor it to the patient’s presentation. Do not omit technical information that may improve understanding.Task 4 (shared understanding)Step 4 (explanation and planning)Safety-netting
3. Offer patients the opportunity to discuss their expectations and concerns and ensure they are addressed in the safety-netting advice.Task 1 (define reason)Steps 1 and 2 (initiating the session and gathering information)Summarising
4. Offer an initial diagnosis and describe the expected natural history with practical instructions for self-care and specific situations that should be cause for concern in the safety-netting advice.Task 4 (shared understanding)Step 4 (explanation and planning)Handover
5. Offer resources that will allow the patient to revisit safety-netting information in their own time.Task 6 (use time and resources appropriately)Step 4 (explanation and planning)Safety-netting
6. Consider using techniques such as ‘chunking’ to improve recall of the safety-netting information.Task 4 (shared understanding)Step 4 (explanation and planning)Safety-netting
7. Offer a safety-netting plan that is sensitive to and addresses factors that may make the patient less receptive to safety-netting advice.Task 3 (choose appropriate action with patient)Steps 2 and 4 (gathering information and explanation and planning)Connecting
8. Offer the patient the opportunity to discuss and share in the decision-making of the safety-netting plan.Tasks 3 and 5 (choose appropriate action with patient and involve the patient)Step 4 (explanation and planning)Handover
9. Offer an explanation for the specific safety-netting plan and follow-up plan, and include a discussion of any uncertainty in the initial diagnosis.Task 5 (involve the patient)Step 4 (explanation and planning)Handover
10. Consider actively checking that the patient understands the safety-netting plan.Task 4 (shared understanding)Steps 4 and 5 (explanation and planning, closing the session)Handover
11. Consider explicitly acknowledging the patient’s greater knowledge and ability to make judgements about their own health.Task 5 (involve the patient)Step 4 (explanation and planning)Handover
12. Offer the patient an opportunity to explicitly agree to the follow-up plan.Task 5 (involve the patient)Step 4 (explanation and planning)Handover
13. Offer the patient an explicit invitation to return for further medical advice, even if it is for the same symptom(s).Task 4 (shared understanding)Step 5 (closing the session)Safety-netting
14. Consider building in elements of safety-netting throughout the consultation to avoid it being rushed at the end of the consultation.AllAllAll
15. Offer sufficient detail about the safety-netting advice in the patient’s medical record that future clinicians are able to understand what care was given and continue it appropriately.---
  • *Recommendations are worded as per the NICE wording convention where ‘offer’ signifies high explanatory credibility of the recommendation and ‘consider’ signifies moderate explanatory credibility.152

  • †Findings where the explanatory credibility of the CMOC was rated at low are not included in these recommendations.

  • CMOC, context, mechanism and outcome configuration; NICE, National Institute for Health and Care Excellence.