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. | All | All | All |
| 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.