Primary care physicians’ perspectives of the survivorship care for older breast cancer survivors: a pilot study

What are the barriers to medical collaboration in community-based integrated care supporting cancer patients? A qualitative analysis of healthcare and long-term care providers' perceptions

BACKGROUND

Patients required comprehensive cancer treatment in the community based on medical collaboration between designated cancer care hospitals and community medical and nursing care facilities to help them live life on their own terms. This study aims to describe the barriers to medical collaboration in community-based integrated care from the perspectives of healthcare providers (HCPs) and long-term care providers (LCPs) supporting cancer patients.

METHODS

Semi-structured interviews were conducted with 88 HCPs and LCPs supporting cancer patients. We analyzed interview data to describe barriers to medical collaboration between designated cancer care hospitals and community medical and nursing care facilities using content analysis in MAXQDA.

RESULTS

Participants were mostly HCPs, with physicians accounting for the largest proportion (27.3%). Totally, 299 codes were integrated into seven barriers to medical collaboration in community-based integrated care, including lack of information provision including life perspectives and a delay in sharing cancer patients' values with HCPs to provide end-of-life care according to the patients' wishes. Furthermore, insufficient coordination of cancer and non-cancer symptom management was identified as a barrier specific to older adults with cancer.

CONCLUSIONS

Barriers related to cancer treatment that integrate lifestyle perspectives, end-of-life care emphasizing patient values, and medical collaboration between cancer and non-cancer care are distinctive. They emphasize the importance of utilizing professionals to connect treatment and lifestyle information, establishing a central coordinating organization led by the DCCH, and developing a community palliative care network. Moreover, connecting cancer and non-cancer care through government and medical collaboration is crucial.

The role of primary care in the cancer care continuum: a qualitative study of cancer survivors' experiences

OBJECTIVE

To explore how cancer survivors have experienced their contacts with primary care after being diagnosed with cancer, focusing on the integration between cancer specialist and primary care, and participants' views on what could make primary care services better at catering to the needs of cancer survivors.

DESIGN

A qualitative study in which data was collected through semi-structured digital focus group interviews and analyzed using a template analysis approach.

SETTING AND SUBJECTS

Adult residents of Skåne, Sweden, who had been diagnosed with and initiated treatment for either of five common cancer forms, recruited through patient advocacy groups.

MAIN OUTCOME MEASURES

A qualitative description of participants' experiences and perceptions as expressed in focus group interview data.

RESULTS

Most participants felt that primary care services had not played a significant role for them, despite patterns of both increased and unmet health needs. Insufficient coordination and communication with specialist cancer care, low availability, lacking personal continuity, low cancer competence and lacking commitment to cancer-related needs were presented as barriers to satisfactory primary care. A strengthened bond between cancer and primary care services, privileged access, and holistic perspectives were all suggested as measures to make primary care more suitable to cancer survivors' needs.

CONCLUSION

The study suggests that cancer survivors experience a range of issues that hinders primary care services from playing a productive role in the cancer care process. The results speak for a need for interventions to remove barriers to satisfactory primary care contacts in this group of patients.KEY POINTSThe growing number of cancer survivors highlights the role of primary care services in the cancer care continuum.Despite the presence of unmet needs, few cancer survivors felt that primary care services had been significant to their care.Survivors identified a number of barriers to satisfactory primary care, including lacking coordination and communication between cancer and primary care.Strengthened links between healthcare services, privileged access, and holistic perspectives were suggested to improve primary care delivery for cancer survivors.

Towards a Postgraduate Oncology Training Model for Family Medicine: Mixed Methods Evaluation of a Breast Oncology Rotation

Background: Family physicians have low knowledge and preparedness to manage patients with cancer. A breast oncology clinical rotation was developed for family medicine residents to address this gap in medical education. Objectives and Methods: A breast oncology rotation for family residents was evaluated using a pre-post knowledge questionnaire and semi-structured interviews comparing rotation (RRs) versus non-rotation (NRRs) residents. Quantitative and qualitative data were collected via a pre-post knowledge questionnaire and semi-structured interviews, respectively. Analysis: Quantitative data were analysed using descriptive statistics and paired t-tests to compare pre-post-rotation knowledge and preparedness. Qualitative data were coded inductively, analysed, and grouped into categories and themes. Data sets were integrated. Results: The study was terminated early due to the COVID-19 pandemic. Six RRs completed the study; 19 and 2 NRRs completed the quantitative and qualitative portions, respectively. RRs’ knowledge scores did not improve, but there was a non-significant increase in preparedness (5.3 to 8.4, p = 0.17) post-rotation. RRs described important rotation outcomes: knowledge of the patient work-up, referral process, and patient treatment trajectory; skills in risk assessment, clinical examination, and empathy, and comfort in counseling. Discussion and Conclusion: Important educational outcomes were obtained despite no change in knowledge scores. This rotation can be adapted to other training programs including an oncology primer to enable trainee integration of new information.

Breast Cancer Survivorship: the Role of Rehabilitation According to the International Classification of Functioning Disability and Health-a Scoping Review

Purpose of Review

The population of breast cancer (BC) survivors is growing due to earlier diagnosis and effective combined treatments. A scoping review was performed to explore the role of rehabilitation in BC survivorship and the major issues in BC survivors with International Classification of Functioning Disability and Health (ICF) perspective.

Recent Findings

The authors searched PubMed from January 1, 2018, up until November 9, 2021. The 65 selected publications were analyzed with the Comprehensive ICF BC Core Set (CCS) perspective and assigned to the categories of the CCS components along with the 3 areas of health (physical, mental, and social health). The multidimensional aspects of BC survivor disability are evident, whereas the topics of the articles concern several categories of the ICF BC CCS and all 3 areas of health. However, the current ICF BC CCS does not include certain categories related to emerging issues of BC survivorship recurring in the papers.

Summary

Rehabilitation is crucial in BC survivorship management to give personalized answers to women beyond BC, and the ICF BC CCS remains an essential tool in rehabilitation assessment for BC survivors although it needs updating.

Challenges of Survivorship for Older Adults Diagnosed with Cancer

Purpose of Review

The purpose of this brief review is to highlight significant recent developments in survivorship research and care of older adults following cancer treatment. The aim is to provide insight into care and support needs of older adults during cancer survivorship as well as directions for future research.

Recent Findings

The numbers of older adult cancer survivors are increasing globally. Increased attention to the interaction between age-related and cancer-related concerns before, during, and after cancer treatment is needed to optimize outcomes and quality of life among older adult survivors. Issues of concern to older survivors, and ones associated with quality of life, include physical and cognitive functioning and emotional well-being. Maintaining activities of daily living, given limitations imposed by cancer treatment and other comorbidities, is of primary importance to older survivors. Evidence concerning the influence of income and rurality, experiences in care coordination and accessing services, and effectiveness of interventions remains scant for older adults during survivorship.

Summary

There is a clear need for further research relating to tailored intervention and health care provider knowledge and education. Emerging issues, such as the use of medical assistance in dying, must be considered in this population.

A Comparative Analysis of the Perception of Cancer Patients and Healthcare Providers (Oncology Physicians, Nurses, Social Workers) in Support of Integrated Community-Linked Cancer Plans

This study aimed to examine the awareness and status of cancer patients and healthcare providers (physicians, nurses and social workers) regarding community linkage, in order to establish a desirable care plan model in a future research project. The survey was conducted via two methods: face-to-face for cancer patients (n = 308) and oncology physicians (n = 210), and due to COVID-19 circumstances, online for nurses (n = 200) and social workers (n = 313). As a result, more than 95% of the healthcare providers responded that cancer patients required community-linked services and discharge plans, whereas 50.7% and 79.2% of cancer patients noted the importance of community-linked services and discharge plans, respectively. Social workers, among healthcare providers, showed the most positive experience about connecting patients to community services since 69.7% of them responded as “excellent”. However, as a group, cancer patients considered the necessity of community-linked service as less important, as only 50.7% responded as agreeing it was necessary. The barriers to community linkage were the lack of communication among the different professions of healthcare providers, and the ambiguity in their roles. The findings of this study will inform future community-linked health research, policies and systems for cancer patients. In particular, an in-depth interview with cancer patients will be required to explore their lack of acknowledgment about the necessity of community-linked services. Therefore, this study is expected to contribute to the improvement and supplementation of cancer policies.

Evaluation of survivorship care plans in patients attending the Sydney Cancer Survivorship Centre

PURPOSE

The transitioning of cancer survivors from active treatment to surveillance care has been described as uncoordinated, with lack of communication between healthcare professionals. Survivorship care plans (SCP) are recommended to bridge this transitioning period and help improve coordination of care. SCP contain individualized information about a survivor's cancer diagnosis, treatment, and recommendations for managing treatment-related side effects and improving lifestyle risk factors for cancer recurrence and chronic disease. The aims of the study were to assess the delivery, usefulness, and compliance with SCP of survivors attending a multidisciplinary survivorship clinic and to determine patient suggestions regarding how to improve SCP.

METHODS

A total of 110 survivors were interviewed in-person or by phone regarding their SCP following a script with formalized questions. Data were analyzed quantitatively using descriptive statistics.

RESULTS

Overall, 65% of participants (72/110) acknowledged having received a SCP and 86% found them useful. Only 11% of survivors (8/72) showed their SCP to other health professionals and about half (33/72) showed it to family/friends. Ninety percent of survivors (65/72) reported following at least one recommendation in their SCP.

CONCLUSION

Survivors found SCP helpful but did not share them with other healthcare providers, which questions their usefulness in coordinating care. There were challenges with SCP delivery. Survivors reported they were compliant with SCP lifestyle recommendations. Further research is required to address the utility of SCP to other stakeholders, such as general practitioners, to determine whether they receive the SCP, if they find them helpful, and their expectations regarding SCP.

Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review

PURPOSE

We sought to examine and categorize the current evidence on patient-physician relationships among marginalized patient populations within the context of cancer care using a systemic scoping review approach.

METHODS

Web-based discovery services (e.g., Google Scholar) and discipline-specific databases (e.g., PubMed) were queried for articles on the patient-physician relationship among marginalized cancer patients. The marginalized populations of interest included (1) race and ethnicity, (2) gender, (3) sexual orientation and gender identity, (4) age, (5) disability, (6) socioeconomic status, and (7) geography (rural/urban). Study screening and data extraction were facilitated through the Covidence software platform.

RESULTS

Of the 397 screened studies, 37 met study criteria-most articles utilized quantitative methodologies (n = 28). The majority of studies focused on racial and ethnic cancer disparities (n = 27) with breast cancer (n = 20) as the most common cancer site. Trust and satisfaction with the provider were the most prevalent issues cited in the patient-physician relationship. Differences in patient-physician communication practices and quality were also frequently discussed. Overall, studies highlighted the need for increased culturally congruent care among providers.

CONCLUSION

Results from this review suggest marginalized cancer patients face significant barriers in establishing culturally and linguistically congruent patient-physician relationships. Future studies should focus on the intersectionality of multiple marginalized identities and optimization of the patient-physician relationship.

Primary care physician's confidence and coordination regarding the survivorship care for older breast cancer survivors

PURPOSE

To examine primary care physician's (PCPs) internal (confidence, training) and external (communication, receipt of survivorship care plans (SCPs)) regarding their provision of survivorship care to older breast cancer survivors METHOD: A web-based questionnaire was completed individually by PCPs about their training and areas of survivorship they address under their care. A subset of survey participants was interviewed about survivorship care for older breast cancer survivors, care coordination, and areas of improvement regarding SCPs.

RESULTS

PCPs (n = 29) had an average 13.5 years in family practice. Forty-five percent surveyed as "somewhat confident" or "not confident" evaluating and managing the late effects of cancer treatment, and 25% surveyed as "somewhat confident" or "not confident" addressing the chronic comorbidities of older breast cancer survivors. More than half of PCPs surveyed that they reach out to their patients' oncologist "a little" or "none of the time" and that they receive SCPs "a little" or "none of the time." Semi-structured interviews also indicated that many PCPs did not receive a SCP from their patients' oncologists and that communication between the two providers regarding survivorship care was poor.

CONCLUSION

Participants indicated that PCP confidence in providing survivorship care is lacking and that lack of training, infrequent communication with oncologists, and underutilization of SCPs may contribute to this lack of confidence. These findings provide insight into the possible need for a well-defined shared care model, which has been encouraged but not always a routine part of survivorship care in various practice settings.

Understanding primary care-oncology relationships within a changing healthcare environment

Background

Management of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment.

Methods

Through a comparative case study of 14 innovative primary care practices throughout the United States (U.S.), we examined relationships between primary care and oncology settings to identify attributes contributing to strengthened relationships in diverse settings. Field researchers observed practices for 10–12 days, recording fieldnotes and conducting interviews. We created a reduced dataset of all text related to primary care-oncology relationships, and collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process.

Results

Nine of the 14 practices discussed having either formal or informal primary care-oncology relationships. Nearly all formal primary care-oncology relationships were embedded within healthcare systems. The majority of private, independent practices had more informal relationships between individual primary care physicians and specific oncologists. Practices with formal relationships noted health system infrastructure that facilitates transfer of patient information and timely referrals. Practices with informal relationships described shared commitment, trust, and rapport with specific oncologists. Regardless of relationship type, challenges reported by primary care settings included lack of clarity about roles and responsibilities during cancer treatment and beyond.

Conclusions

With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate strengths of informal primary care-oncology relationships in addition to formal system driven relationships.