Development of a toot for coding safety-netting behaviours in primary care: a mixed-methods study using existing UK consultation recordings

Background Safety netting is recommended in a variety of clinical settings, yet them are no tools to record clinician safety-netting communication behaviours. Aim To develop and assess the inter-rater reliability (IRR) of a coding tool designed to assess safety netting communication behaviours in primary care consultations Design and setting A fluxed-methods study using an existing dataset of video- and audio-recorded UK primary care consultations. Method Key components that should be assessed in a coding tool were identified using the published literature and relevant guidelines. An iterative approach was utilised to continuously refine and generate new codes based on the application to real-life consultations. After the codebook had been generated, it was applied to 35 problems in 24 consultations independently by two coders. IRR scores were then calculated. Results The tool allows for the identification and quantification of the key elements of safety-netting advice including: who initiates the advice and at which stage of the consultation; the number of symptoms or conditions the patient is advised to look out for; what action patients should take and how urgently; as well as capturing how patients respond to such advice plus important contextual codes such as the communication of diagnostic uncertainty, the expected time course of an illness, and any follow-up plans. I he final tool had substantial levels of IRR with the mean average agreement for the final tool being 88% (kappa=0.66). Conclusion The authors have developed a novel tool that can reliably code the extent of clinician safetynetting communication b ehaviours.