KFP – Research in General Practice

Claudia Jenkins, a 64-year-old woman with type 2 diabetes and hypertension, attends your practice for a routine check-up. During the consultation, she mentions that her neighbour is participating in a research study on a new medication for lowering blood pressure, run by a nearby university. Claudia expresses interest in being involved in similar research, stating that she wants to contribute to science and might benefit from newer treatments.

You are aware that your practice is one of several recruiting for a government-funded general practice research project investigating a digital intervention for diabetes management. You explain the study briefly and give Claudia the participant information sheet to take home.

At her follow-up appointment a week later, Claudia returns with questions about the study’s randomisation process and potential risks. She also wants to know whether participating will affect her current treatment or the continuity of her care with you.

Medications: Metformin 1000 mg BD, Perindopril 5 mg daily, Atorvastatin 20 mg daily

Past history: Type 2 diabetes (diagnosed 8 years ago), hypertension, hyperlipidaemia

Social history: Retired librarian, lives alone, volunteers at local library

Preventative healthcare: Last mammogram and bowel screening within 2 years, non-smoker, occasional wine

What are the most appropriate steps in addressing Claudia’s interest and concerns about the research study? Select three (3) from the following list:

Dr. Ayesha Mirza is a GP working in a mixed billing suburban clinic. She has recently completed training in research methods and is leading a quality improvement study to assess the effect of delayed antibiotic prescribing for acute otitis media in children aged 2–12 years. The study is funded by a local primary health network and has ethics approval.

To collect data, participating GPs are asked to complete a checklist at the time of consultation and provide patients with a script marked ‘delayed use’ alongside a patient education leaflet. At the end of the consult, patients are invited to complete a satisfaction survey. Consent forms are signed by the parent or guardian prior to participation.

One of Dr. Mirza’s colleagues, Dr. Jonathan Lee, expresses concern that completing the checklist during the consultation might slow things down too much and affect his billing. He also questions whether it’s ethical to ask parents to complete surveys when their child is unwell. A registrar at the clinic also asks whether GPs can be considered researchers or if that is only for academics in universities.

What are the most appropriate considerations in relation to this research project? Select three (3) from the following list:

Dr. Benjamin Huang is a GP supervisor at a regional training practice. He is supervising Olivia Grant, a GPT3 registrar, who is interested in exploring antibiotic prescribing patterns for sore throat presentations in the practice. Olivia proposes a small audit of 30 patient records from the past 3 months to identify how often antibiotics were prescribed and whether prescribing aligned with current guidelines. She also wants to present the findings at the next local PHN meeting.

Dr. Huang advises her to proceed but raises questions about whether ethics approval is needed and how to handle patient confidentiality. Olivia plans to de-identify all data before analysis. She has completed RACGP online training on research in general practice.

What are the most appropriate steps for Olivia to take in conducting this research audit? Select three (3) from the following list:

Samuel O’Dwyer, a 52-year-old man with moderate COPD, presents for his regular review. He mentions being approached at the local pharmacy to join a research project testing an inhaled herbal supplement aimed at improving lung function. The study is being run by an overseas company and advertised in the community pharmacy with a flyer offering participants $100 on completion. The study requires participants to stop their usual inhalers for 48 hours before starting the trial medication.

Samuel is keen to try the supplement, believing it may help him reduce reliance on medication. He asks you if you think the trial is safe and if he should participate.

Medications: Tiotropium inhaler daily, Salbutamol PRN

Past history: COPD, ex-smoker (quit 2 years ago), hypertension, dyslipidaemia

What are the most appropriate responses and actions regarding Samuel’s inquiry about the trial? Select three (3) from the following list:

Dr. Farah Sheikh is involved in a national general practice research project investigating the impact of routine social determinants screening in adult health checks. The study involves using a short electronic questionnaire in the waiting room, asking patients about housing, employment, financial stress, and food security. The project has full ethics approval, and patient participation is voluntary.

John Ridley, aged 47, presents for his annual health check. He agrees to complete the questionnaire but later becomes upset during the consultation, stating that he didn’t realise questions about financial stress would be included. He is embarrassed and asks if his answers will be seen by anyone outside the clinic.

Past history: Hypertension, generalised anxiety disorder, smoker (15/day), lives alone

What are the most appropriate actions and considerations in managing John’s concerns during the research process? Select three (3) from the following list:

Dr. Helen Varga is the lead GP for a pilot study investigating the use of wearable devices to monitor physical activity in older adults with type 2 diabetes. The study recruits patients aged 60 and over, who are given a fitness tracker for three months. They receive text-message feedback and goal setting through the practice system. The study is funded by a university research grant and has ethics approval.

Josephine Tran, a 68-year-old participant, presents to the clinic complaining of stress related to receiving text messages she doesn’t fully understand. She says the device makes her feel like she is being monitored constantly and worries it is tracking her location. She is considering withdrawing from the study.

Past history: Type 2 diabetes, osteoarthritis, mild anxiety

Medications: Metformin, paracetamol PRN

What are the most appropriate actions and considerations for Josephine? Select three (3) from the following list:

Dr. Luke Patel is part of a research collaboration evaluating the impact of culturally adapted mental health screening tools in Aboriginal and Torres Strait Islander patients. The study uses a modified questionnaire developed in consultation with local Elders and Aboriginal Health Workers. Patients attending for general health checks are offered the screening tool and asked for feedback. The study has been approved by both a university HREC and the local Aboriginal health research ethics committee.

Naomi Walker, a 34-year-old Aboriginal woman, attends for a routine health check and is offered the questionnaire. She expresses reluctance, stating that she’s been ‘messed around’ in the past by people asking questions but doing nothing with the answers. She asks whether participating will change anything for her community.

Past history: Depression, smoking (10/day), caring for two young children

What are the most appropriate responses to Naomi’s concerns? Select three (3) from the following list:

Dr. Nisha Rao is working with her rural general practice team to evaluate the effectiveness of a telehealth follow-up service for patients recently discharged from hospital with heart failure. The study compares 30-day readmission rates between patients who received a standard follow-up and those who received weekly telehealth check-ins. The study involves collecting non-identifiable hospital discharge data and follow-up outcomes through the practice’s clinical software system.

David Pritchard, the practice manager, raises concerns about whether the clinic needs explicit consent from each patient since the data is already in the medical records and will be de-identified. Dr. Rao is unsure and seeks guidance before proceeding.

What are the most appropriate next steps in managing this concern about data use in research? Select three (3) from the following list:

Dr. Emily Zhang is involved in a practice-based research project evaluating a new shared decision-making tool for patients with chronic back pain. The tool is a web-based program used during consultations to guide discussions on imaging, medication, and non-pharmacological management options. The project includes video-recording consultations for later analysis of communication style and decision-making processes. Ethics approval has been granted.

Michael Bryant, a 44-year-old participant with chronic back pain, agrees to use the tool but becomes concerned when asked to consent to video-recording. He says he doesn’t want to be “on camera” and is unsure why this is necessary. He is worried about privacy and whether the videos could be shared beyond the research team.

Medications: Ibuprofen PRN, physiotherapy fortnightly

Social history: Works as a warehouse supervisor, lives with partner and two children

What are the most appropriate responses and actions regarding Michael’s concerns? Select three (3) from the following list:

Dr. Patrick O’Connell is collaborating with a local university on a study evaluating vaccine hesitancy in parents of young children. The research involves semi-structured interviews conducted by medical students, who are placed at the practice for clinical experience. The students will audio-record interviews with consenting parents and later transcribe the conversations for thematic analysis. Ethics approval has been granted, and the study protocol includes supervision by the academic team.

Amira Yusuf, a mother of two children under five, agrees to participate but becomes concerned when she realises the interviewer is a student. She asks if the student has access to her medical records and whether her comments could affect how the clinic views her parenting.

Children’s health: Up to date with immunisations, both have mild asthma

What are the most appropriate actions in response to Amira’s concerns? Select three (3) from the following list:

Dr. Anita Desai is involved in a multi-site general practice study evaluating the effectiveness of SMS reminders in improving cervical screening participation among women aged 25–74 years. The study uses the practice’s clinical software to identify eligible patients who have not had a screening test in the past 5 years. The software generates automated SMS reminders containing information about booking a cervical screening test at the practice. The study has received ethics approval, including a waiver of individual consent for the initial SMS reminder due to the minimal risk involved.

Fatima Khoury, aged 41, receives the SMS and attends the clinic visibly upset. She tells Dr. Desai she felt embarrassed receiving a message about cervical screening on her shared mobile phone, which her teenage daughter also uses. Fatima was not aware she would receive such messages and is worried about who else may have seen it.

Past history: Anxiety, recent migration, no previous cervical screening recorded

What are the most appropriate actions in response to Fatima’s concerns? Select three (3) from the following list:

Dr. Carla Mendes is participating in a general practice research project evaluating the effectiveness of a new online portal that allows patients to self-report symptoms of depression and anxiety before their consultation. The data is intended to help guide the consultation and identify patients who may benefit from early mental health intervention. The project has ethics approval and includes a protocol for managing high-risk responses, including an alert to the GP if a patient reports suicidal thoughts.

Mark Johnson, aged 36, completes the questionnaire on his phone in the waiting room. His answers trigger a suicide risk flag, but he leaves the clinic before seeing the doctor due to a long wait. Reception notifies Dr. Mendes after he has left. His contact details are up to date, and he is a regular patient at the practice.

Past history: Generalised anxiety disorder, no recorded suicide attempts, lives alone

What are the most appropriate immediate actions for Dr. Mendes to take? Select three (3) from the following list:

Dr. Omar Saleh is collaborating on a general practice-based research study that explores barriers to chronic disease management in culturally and linguistically diverse (CALD) populations. The study involves bilingual research assistants conducting interviews with patients in their preferred language. These interviews are audio-recorded, transcribed, and then translated into English for thematic analysis. Ethics approval has been obtained, including protocols for interpreter use and culturally appropriate consent processes.

Layla Hassan, a 58-year-old Arabic-speaking patient with poorly controlled type 2 diabetes, is invited to participate during her routine check-up. The bilingual research assistant explains the study, and Layla agrees. However, midway through the interview, Layla becomes tearful when asked about family support. She says she thought the interview would be only about medications and doesn’t want to continue.

Medications: Metformin, gliclazide, rosuvastatin

Social history: Lives with extended family, recent bereavement, limited English proficiency

What are the most appropriate actions in response to Layla’s distress during the research interview? Select three (3) from the following list:

Dr. James McMillan is working with a group of general practices participating in a registry study evaluating outcomes in patients with atrial fibrillation (AF). The registry collects anonymised data directly from practice electronic medical records, including diagnosis codes, prescribed medications, and relevant pathology results. No identifiable information is collected, and the project has received full ethics approval including a waiver of individual consent.

During a routine clinical meeting, one of the nurses, Rachel, expresses concern that patients haven’t been asked for permission and that they may feel their privacy has been breached if they find out. She worries this could damage the trust patients have in the practice.

Practice setting: Suburban group practice with shared care model and nurse-led chronic disease management clinics

What are the most appropriate responses and actions to Rachel’s concerns? Select three (3) from the following list:

Dr. Sinead O’Reilly is supervising a final-year medical student, Daniel, who is conducting a qualitative research project on the experiences of patients living with long COVID in general practice. The project has university ethics approval and involves one-on-one interviews with participants recruited through the practice’s chronic disease register. Daniel has completed Good Clinical Practice (GCP) training and is working under supervision.

After interviewing one participant, Daniel asks Dr. O’Reilly whether he can also conduct a quick post-interview clinical review because the patient mentioned feeling ‘a bit short of breath lately’ and didn’t want to book another appointment. He offers to document his findings in the clinical record and provide a summary to Dr. O’Reilly.

Setting: Outer metropolitan group practice with teaching accreditation

What are the most appropriate responses and actions in this scenario? Select three (3) from the following list:

Dr. Sarah Tien is leading a general practice quality improvement (QI) initiative evaluating the implementation of a new electronic clinical reminder system to increase screening for diabetic complications. The project involves tracking rates of annual eye, foot, and kidney checks before and after the system is activated. It uses existing clinical software to collect aggregate practice-level data. The team plans to present results at a regional conference and publish in a peer-reviewed journal.

One of the registrars, Dr. Noah Kim, asks whether this project counts as research or QI, and whether it requires ethics approval and patient consent. He also asks if the results can be shared externally without ethics committee review if individual patient data isn’t involved.

What are the most appropriate responses to clarify the project’s governance and ethics requirements? Select three (3) from the following list:

Dr. Leena Rao is participating in a research project evaluating the impact of personalised health goal-setting for patients with multiple chronic diseases. As part of the study, participants co-design their goals with a GP or practice nurse, and follow-up data is collected on progress, hospitalisations, and medication changes over six months. The study uses a mixed methods design and has full ethics approval. The consent process includes discussing data sharing for de-identified health outcomes.

Peter Lang, aged 72, agrees to participate. At his 3-month review, he mentions he’s unsure whether he truly consented to be part of “a study” and thought it was just part of his usual care. He seems confused about what’s being recorded and how the information will be used.

Past history: Type 2 diabetes, ischaemic heart disease, COPD

Medications: Metformin, bisoprolol, tiotropium, aspirin

What are the most appropriate responses and actions in this situation? Select three (3) from the following list:

Dr. Marcus Bell is part of a national general practice research project evaluating the effectiveness of brief alcohol interventions delivered via telehealth. The study involves GPs providing a standardised 5-minute counselling script to patients who screen positive for risky drinking on a pre-consultation questionnaire. Follow-up surveys are sent at 1 and 3 months. The study has ethics approval, including consent procedures and guidance for managing disclosures of harmful drinking.

During a consultation, 28-year-old patient Kayla Nguyen screens positive and agrees to participate. During the scripted intervention, she discloses drinking heavily to cope with anxiety and mentions having blacked out on several occasions. She asks Dr. Bell not to write this in her notes because she doesn’t want it affecting her job as a paramedic.

Past history: Anxiety disorder, no previous alcohol-related documentation

Current medications: Sertraline 100mg daily

What are the most appropriate responses and actions in this situation? Select three (3) from the following list:

Dr. Fiona Walsh is part of a rural general practice involved in a cluster randomised trial comparing two models of chronic disease care. The practice was randomised to the intervention arm, which involves an additional monthly nurse-led review for patients with diabetes and hypertension. These reviews include structured data collection for research purposes. Ethics approval has been granted, including cluster-level consent at the practice level and individual patient opt-out information provided via post prior to commencement.

One patient, Dennis Cole, aged 75, attends for his usual check-up and is surprised to find the nurse using a new form and asking different questions. He says he never agreed to be part of any study and feels like he was ‘used for research without knowing.’

Past history: Type 2 diabetes, hypertension, stage 2 CKD

What are the most appropriate responses and actions in response to Dennis’s concern? Select three (3) from the following list:

Dr. Julia Tan is contributing to a practice-based research study examining health literacy and its impact on medication adherence in patients with chronic illnesses. The study involves patients completing a short health literacy questionnaire and providing consent to link their responses to medication prescribing data from the electronic medical record. The study has full ethics approval and includes a process for obtaining written informed consent.

During recruitment, several patients express interest but are unable to read the consent form due to low literacy or vision impairment. One patient, George, aged 66, asks if Dr. Tan can just explain it verbally and sign the form on his behalf so he can be included in the study.

Past history: Hypertension, osteoarthritis, visual impairment (diabetic retinopathy)

What are the most appropriate responses and actions regarding consent in this context? Select three (3) from the following list:

Dr. Nathan Li is contributing data from his rural general practice to a national database tracking antibiotic prescribing trends for respiratory tract infections. The project involves de-identified prescribing data extracted directly from the practice’s clinical software every quarter. Ethics approval has been obtained, and practices were provided with template privacy notices to inform patients that their data may be used for research in de-identified form.

At a community health forum, a patient raises concerns that their prescriptions are being used for research without their knowledge. They ask whether they can opt out, and whether the data could ever be re-identified.

Setting: Rural general practice with a large Aboriginal and Torres Strait Islander patient population

What are the most appropriate responses and actions to address these concerns? Select three (3) from the following list:

Dr. Amal Bhatti is working with a university team on a project investigating physical activity promotion strategies in general practice. The study involves brief interventions delivered by GPs during routine visits and a follow-up phone call by a research assistant two weeks later. Patients provide written consent for participation and data collection. One of Dr. Bhatti’s patients, 61-year-old Robert Jenkins, agrees to participate but becomes irritated when he receives the follow-up call, saying he didn’t expect to be contacted outside the clinic and finds it intrusive.

Robert expresses frustration that he was not ‘properly told’ about the phone calls and wants to withdraw from the study immediately. He also asks to have all his information deleted.

Past history: Obesity, hypertension, chronic knee pain

Current medications: Perindopril, paracetamol PRN

What are the most appropriate responses and actions to take in response to Robert’s concerns? Select three (3) from the following list:

Dr. Tomiwa Adeyemi is supervising a research project involving Aboriginal and Torres Strait Islander patients with type 2 diabetes, examining barriers to medication adherence. The project includes culturally adapted interviews co-designed with local Elders and Aboriginal Health Workers, and ethics approval was obtained from both a university HREC and an Aboriginal-specific ethics committee. One of the participants, Raylene, aged 49, shares a deeply personal story during her interview and later becomes concerned that her words might be quoted in a publication, even if not named.

She contacts the clinic and asks whether she can review anything written about her before it is shared more widely. She says she felt safe sharing but now worries it might be misunderstood out of context.

Social history: Lives in a remote community, cares for grandchildren, recently started insulin

What are the most appropriate responses and actions regarding Raylene’s concern? Select three (3) from the following list:

Dr. Eliza Moore is collaborating on a research project studying health behaviours in adolescents attending general practice. The study uses a digital tablet-based survey completed in the waiting room, covering diet, exercise, smoking, alcohol, and sexual health. Adolescents aged 14–17 can self-consent, as approved by the ethics committee. The survey is confidential, and results are not routinely shared with parents or clinicians unless the participant requests follow-up or discloses serious risk (e.g. suicidality).

One 15-year-old participant, Jackson, completes the survey and discloses regular binge drinking and recent unprotected sex but indicates that he does not want this discussed with his GP or parents. The system does not flag any immediate harm requiring escalation. His GP, Dr. Moore, reviews the dashboard and is unsure whether she can initiate a discussion in the consult.

Setting: Mixed-billing suburban practice with adolescent-friendly services

What are the most appropriate actions for Dr. Moore in this situation? Select three (3) from the following list:

Dr. Ashwin Menon is a general practitioner contributing to a national research project investigating prescribing safety in patients aged 75 and over. The study uses electronic prescribing data to flag potentially inappropriate medications (PIMs) based on criteria such as polypharmacy, renal function, and drug interactions. The alerts are reviewed by the research team but not integrated into the clinical software. Dr. Menon receives an email listing several of his patients who were flagged by the system, including one, Dorothy, who is on multiple medications including benzodiazepines. The message suggests these cases may benefit from a medication review but notes that direct intervention is not required as part of the study.

Dr. Menon is unsure how to approach Dorothy’s care now that this information has been provided, especially as she has been stable on her medications for years and is reluctant to make changes.

Patient: Dorothy, aged 83, lives independently, sees her GP monthly, takes 8 regular medications

What are the most appropriate responses and actions for Dr. Menon? Select three (3) from the following list:

Dr. Mia Leung is participating in a general practice research study that explores the acceptability of patient-reported outcome measures (PROMs) for chronic pain. Patients are invited to complete a short questionnaire before and after their consultation, reflecting on pain severity, daily function, and treatment satisfaction. One patient, Luke, aged 45, completes the pre-consultation PROM but forgets to fill in the post-consultation version. A practice nurse asks if she can assist him to complete it while he’s waiting for his pathology form.

Luke says he doesn’t mind, but seems unsure what the questions mean. He looks fatigued and anxious and says, “Just tick the middle box, that’s probably about right.”

Past history: Chronic back pain, depression, past opioid use disorder

Current medications: Duloxetine, PRN ibuprofen

What are the most appropriate responses and actions for the research team? Select three (3) from the following list:

Dr. Helena Cruz is participating in a general practice research study examining the impact of providing tailored written action plans for patients with asthma. The study involves randomising eligible patients to receive either standard care or a personalised asthma action plan generated by a software tool. The research assistant at the practice explains the study and obtains consent before randomisation. During a follow-up consultation, a participant, Simon (aged 32), says he’s frustrated because he expected to receive an action plan but was instead given usual care. He feels the study is unfair and says, “I thought you were trying to help people.”

Past history: Mild persistent asthma, eczema, hay fever

Medications: Salbutamol PRN, budesonide/formoterol

What are the most appropriate responses to Simon’s concerns? Select three (3) from the following list:

Dr. Karen Aboud is participating in a research study exploring the integration of genomic testing into general practice for patients with a family history of cancer. Eligible patients are offered a saliva test to assess genetic risk for hereditary cancer syndromes. The study includes pre- and post-test counselling and follows strict ethics protocols for informed consent, privacy, and genetic counselling referrals if needed.

Alan, a 39-year-old participant, completes the test and receives a result indicating a pathogenic BRCA2 mutation. He is distressed and asks Dr. Aboud if this means his children will definitely get cancer. He also asks if the result will affect his ability to get life insurance or a mortgage.

Family history: Mother had breast cancer at age 44; maternal aunt with ovarian cancer

Past history: Nil significant

What are the most appropriate responses and actions in this situation? Select three (3) from the following list:

Dr. Rachel Lim is participating in a research project investigating the impact of using AI-assisted triage tools in general practice. The AI system suggests differential diagnoses and triage levels based on patient-reported symptoms entered before the consultation. Patients are informed they are part of a study evaluating decision support tools and provide consent for their data to be analysed. One of Dr. Lim’s patients, Tom, aged 51, becomes upset when she asks fewer questions than usual, stating, “It feels like you’re relying on the computer more than listening to me.”

Past history: GORD, mild depression

Presenting complaint: Chest discomfort and fatigue

What are the most appropriate responses and actions in response to Tom’s concerns? Select three (3) from the following list:

Dr. Anika Bose is involved in a qualitative research project examining the experiences of carers who support patients with dementia in general practice. The study involves in-depth interviews conducted at the clinic or via phone. Participants receive a $30 supermarket voucher as a thank you, which was approved by the ethics committee. One participant, Steve, aged 56, caring for his father with advanced Alzheimer’s disease, becomes emotional during the interview and later tells Dr. Bose he feels guilty accepting money for “talking about something so personal.” He asks if he can return the voucher or donate it instead.

Social history: Lives with elderly father, sole carer, employed part-time

What are the most appropriate responses to Steve’s concerns? Select three (3) from the following list:

Dr. Samuel Tran is supporting a pilot study testing a mobile app designed to support medication adherence in patients with cardiovascular disease. The app includes daily reminders, motivational messages, and weekly self-report prompts. Patients are provided with instructions and contact details for technical support. During a follow-up visit, one participant, Joan, aged 70, reports that the app keeps crashing on her phone. She has stopped using it and says she feels “like a failure” for not keeping up. She asks whether this will affect her participation or the care she receives at the practice.

Past history: Hypertension, prior myocardial infarction, osteoarthritis

Medications: Aspirin, atenolol, atorvastatin

What are the most appropriate responses and actions for Dr. Tran? Select three (3) from the following list:

Dr. Olivia Kerr is contributing to a longitudinal general practice research study investigating lifestyle factors influencing the development of type 2 diabetes. Participants complete a comprehensive baseline survey, including sensitive topics such as alcohol use, dietary habits, physical activity, and mental health. The data is de-identified and stored securely. One participant, Richard, aged 54, completes the survey but later calls the practice distressed, saying he regrets disclosing his alcohol intake. He worries it will impact his employment or insurance and asks if his responses can be deleted.

Past history: Overweight, borderline fasting glucose, works in mining sector

What are the most appropriate responses and actions to take? Select three (3) from the following list:

Dr. Narelle James is involved in a general practice research study on digital health literacy. The study includes a short survey and a practical task where participants navigate an online health information site and answer questions. One participant, Helen, aged 67, becomes flustered during the session, saying she isn’t confident using computers and is embarrassed. She asks if she can skip the task but still be included in the study, as she wants to contribute but doesn’t want to ‘feel stupid.’

Past history: Hypertension, mild hearing loss, no regular computer use

What are the most appropriate responses to Helen’s concerns? Select three (3) from the following list:

Dr. Yusuf Karim is contributing to a general practice research study on early detection of cognitive decline using brief screening tools administered annually to patients over 65. The study has ethics approval and includes verbal consent before each screen. During a routine visit, 68-year-old patient Shirley agrees to participate. She scores below the cutoff on the tool, suggesting mild cognitive impairment. She becomes visibly upset and asks, “Does this mean I’m getting dementia? Will you tell my family?”

Past history: Hyperlipidaemia, mild hearing loss

Medications: Atorvastatin, aspirin

What are the most appropriate responses and actions for Dr. Karim? Select three (3) from the following list:

Dr. Leo Grant is working on a practice-based research project evaluating the implementation of a new electronic health risk assessment tool for patients aged 40–49. The tool collects self-reported data on diet, exercise, alcohol, smoking, and mental health, and generates a risk summary that can be discussed during the consultation. Patients consent to the use of their de-identified data for research. One participant, Amelia, aged 43, becomes upset when the tool flags her as ‘high risk’ for alcohol use. She tells Dr. Grant, “I only drink a few wines at night – how is that high risk?” and says she regrets completing the questionnaire.

Past history: Migraine, stress-related insomnia

Medications: Zolpidem PRN, ibuprofen

What are the most appropriate responses to Amelia’s concern? Select three (3) from the following list:

Dr. Chloe Tan is participating in a study exploring the impact of advance care planning (ACP) discussions in general practice. The research protocol involves GPs initiating ACP conversations with eligible patients aged 70 and over during routine health assessments. Participants are provided with a written summary of the discussion, and their de-identified responses are analysed for research purposes. One participant, Margaret, aged 74, becomes visibly distressed during the conversation and says, “I don’t want to think about dying right now.” She asks if the questions are mandatory and if refusing will affect her care.

Past history: Type 2 diabetes, osteoarthritis, cataracts

Medications: Metformin, paracetamol, vitamin D

What are the most appropriate responses and actions for Dr. Tan? Select three (3) from the following list:

Dr. Marcus Ellis is involved in a research project assessing the impact of a new multilingual patient portal for managing chronic conditions. The study includes patients who speak languages other than English and provides translations of key health information, appointment bookings, and medication reminders. One participant, Linh, a 62-year-old Vietnamese-speaking patient with type 2 diabetes, becomes confused about a translated message suggesting she may need to adjust her insulin. She is unsure whether this is a research suggestion or clinical instruction and contacts the practice concerned.

Past history: Type 2 diabetes, hypertension, hyperlipidaemia

Medications: Metformin, insulin glargine, amlodipine, atorvastatin

What are the most appropriate responses and actions for Dr. Ellis and the research team? Select three (3) from the following list:

Dr. Aditi Sharma is involved in a research study evaluating the use of wearable fitness trackers to promote physical activity in patients with cardiovascular risk factors. Participants wear a device for 12 weeks and have data uploaded to a secure research database. One participant, Bruce, aged 59, presents for his 6-week review and expresses concern that the device might be tracking his location. He says, “I feel like I’m being watched all the time,” and asks whether the device can be used to monitor where he goes.

Past history: Hypercholesterolaemia, obesity, mild anxiety

Medications: Atorvastatin, esomeprazole

What are the most appropriate responses and actions for Dr. Sharma? Select three (3) from the following list:

Dr. Elaine Rowe is participating in a research study on shared decision-making in general practice consultations for patients with chronic kidney disease (CKD). The study involves audio-recording routine consultations to analyse communication patterns. Patients are provided with an information sheet and sign a written consent form before the recording. During a review consultation, Michael, a 66-year-old patient with stage 3 CKD, agrees to the recording but becomes quiet and hesitant during the discussion of treatment options. At the end of the consult, he asks, “Will this recording be played to people I don’t know?”

Past history: CKD stage 3, hypertension, osteoarthritis

Medications: Perindopril, paracetamol

What are the most appropriate responses to Michael’s question and concern? Select three (3) from the following list:

Dr. Hannah Reid is part of a research team conducting a pragmatic trial in general practice comparing two models of care for depression: usual GP care versus GP care with adjunctive digital CBT (cognitive behavioural therapy). Patients are randomised after providing informed consent. One participant, James, aged 29, is allocated to the digital CBT group but emails Dr. Reid two weeks later saying he hasn’t used the app, doesn’t like “doing therapy on a screen,” and wants to switch to the other group. He asks, “Can I just go back to normal care instead?”

Past history: Generalised anxiety disorder, recurrent depression

Medications: Sertraline 100 mg daily

What are the most appropriate responses and actions? Select three (3) from the following list:

Dr. Sarah Noble is involved in a research project assessing barriers to cancer screening in general practice. The study includes short anonymous surveys administered to patients in the waiting room. One survey question asks about reasons for missing past screening tests, including options like ‘fear of results’, ‘cultural beliefs’, and ‘past trauma’. During clinic hours, a receptionist informs Dr. Noble that a patient, Anna, aged 52, became upset after reading the survey and left the clinic before her appointment, saying the questions were “too personal”.

Past history: Anxiety, irregular cervical screening history

What are the most appropriate responses and actions in this situation? Select three (3) from the following list:

Dr. Leo Spencer is participating in a study evaluating the implementation of pharmacogenomic testing in general practice. Patients with depression who are starting or changing antidepressant therapy are offered a cheek swab test to help guide medication choice based on genetic markers of metabolism. The study has ethics approval and involves pre- and post-test counselling. One participant, Meera, aged 34, receives a result indicating she may have slower metabolism of certain SSRIs. She becomes anxious, asking, “Does this mean I’m broken? Will I ever get better?”

Past history: Generalised anxiety disorder, major depressive disorder

Medications: Recently stopped escitalopram; planning to trial sertraline

What are the most appropriate responses and actions for Dr. Spencer? Select three (3) from the following list:

Dr. Angela Pham is involved in a general practice-based study evaluating the impact of a social prescribing intervention for patients with mild to moderate depression. Eligible participants are referred to a ‘link worker’ who assists them in accessing community services such as exercise programs, volunteer work, or art classes. The study includes structured follow-up surveys at 3 and 6 months. One participant, Lionel, aged 64, stops attending appointments after two months and is later contacted by phone. He says, “This isn’t helping. I feel worse. I don’t want to be part of this anymore, and I don’t want anyone else calling me.”

Past history: Mild depression, social isolation, osteoarthritis

Medications: Citalopram 20 mg daily

What are the most appropriate responses and actions for the research team? Select three (3) from the following list:

Dr. Michael Youssef is part of a general practice-led research project evaluating the impact of an electronic opioid prescribing alert system aimed at reducing long-term opioid use. The system provides GPs with pop-up messages during prescribing if a patient has been on opioids for more than 90 days. Patients are not directly notified of their inclusion, as only de-identified prescribing data is used. During a consultation, a patient, Carla, aged 58, asks why her usual prescription process now feels “different” and wonders if she is “on some kind of list.”

Past history: Chronic low back pain, long-term oxycodone use

Medications: Oxycodone modified release 10 mg BD

What are the most appropriate responses to Carla’s concerns? Select three (3) from the following list:

Dr. Tara Henderson is involved in a research project assessing the feasibility of integrating patient-reported outcome measures (PROMs) into chronic disease management plans in general practice. Patients with conditions such as diabetes, COPD, and heart failure are asked to complete a PROM tool every three months. These tools assess quality of life, symptom burden, and treatment satisfaction. One participant, Graham, aged 76, who has COPD, tells the practice nurse that the PROM questions are too repetitive and not relevant to how he experiences his illness. He asks, “Do I really need to keep doing this? It feels like a waste of time.”

Past history: COPD (GOLD stage 2), hypertension, former smoker

Medications: Tiotropium inhaler, salbutamol PRN, amlodipine

What are the most appropriate responses to Graham’s concern? Select three (3) from the following list:

Dr. Naomi Field is involved in a research project that evaluates the use of AI-generated patient education leaflets tailored to clinical diagnoses in general practice. The leaflets are automatically generated based on coding entered during the consultation and are printed or emailed to patients after the visit. A week after seeing Dr. Field, a patient named Barry, aged 61, returns, confused and distressed after receiving a leaflet about ‘chronic kidney disease’—a diagnosis he was unaware of. He says, “Is there something wrong with my kidneys? Why didn’t you tell me?”

Past history: Hypertension, gout, stage 2 CKD (not previously discussed)

Medications: Perindopril, allopurinol

What are the most appropriate responses and actions in this scenario? Select three (3) from the following list:

Dr. Jonathan Ng is part of a general practice research project that collects biospecimens (blood and saliva) from patients with metabolic syndrome for future use in biobanking. The study involves detailed consent explaining that samples may be used in other approved studies and shared with external research institutions. A patient, Diana, aged 57, initially consents and provides both samples. Two weeks later, she returns to the clinic and says she has changed her mind after reading a news article about genetic data misuse. She asks if her samples and associated data can be destroyed.

Past history: Obesity, hypertension, impaired glucose tolerance

Medications: Metformin XR, amlodipine

What are the most appropriate responses and actions? Select three (3) from the following list:

Dr. Claire Jamieson is contributing to a research project evaluating the impact of a virtual group education program for patients newly diagnosed with type 2 diabetes. Participants attend four weekly online sessions facilitated by a diabetes educator and are provided with links to join via email or SMS. A participant, Ahmad, aged 63, missed all sessions and, when contacted for follow-up, reveals he didn’t know how to use the video platform and felt too embarrassed to ask for help. He apologises and asks if he can still be included in the research even though he didn’t attend.

Past history: Type 2 diabetes (diagnosed 6 weeks ago), hypertension

Medications: Metformin XR, telmisartan

What are the most appropriate responses and actions? Select three (3) from the following list:

Dr. Ben Wallace is involved in a research study evaluating the effectiveness of SMS reminders for follow-up blood tests in patients with hyperlipidaemia. Patients who consent to participate receive a text message 2 weeks after their consultation prompting them to book their lipid profile. A patient, Angela, aged 47, receives the SMS but becomes alarmed, thinking it means something is wrong. She attends the clinic unannounced, distressed and asking, “Why didn’t you call me? Am I in danger?”

Past history: Hyperlipidaemia, anxiety disorder

Medications: Atorvastatin 20 mg daily

What are the most appropriate responses and actions for Dr. Wallace? Select three (3) from the following list:

Dr. Elise Morton is leading a research project evaluating how environmental sustainability initiatives in general practice affect patient engagement. The study includes a brief survey given to patients after consultations, asking about their awareness of practice sustainability efforts (e.g. paperless records, reduced plastic use, solar energy) and whether these influence their trust or satisfaction. One patient, Brian, aged 72, refuses the survey, saying, “This has nothing to do with medicine. I don’t want politics mixed into my healthcare.”

Past history: Ischaemic heart disease, hyperlipidaemia

Medications: Aspirin, rosuvastatin, bisoprolol

What are the most appropriate responses and actions? Select three (3) from the following list: