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Sandell T, Schütze H, Miller A, Ivers R. Patients' acceptance of a shared cancer follow-up model of care between general practitioners and radiation oncologists: A population-based survey using the theoretical Framework of Acceptability. BMC PRIMARY CARE 2023; 24:86. [PMID: 36973691 PMCID: PMC10044765 DOI: 10.1186/s12875-023-02032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION International and national guidelines highlight the need for general practitioner involvement during and after active cancer treatment and throughout long-term follow-up care. This paper aimed to evaluate patients' acceptance of radiation oncology shared follow-up care using the Theoretical Framework of Acceptability (TFA). METHODS This cross-sectional study was conducted at two cancer care centres in the Illawarra Shoalhaven region of Australia. A sample of patients scheduled for a radiation oncology follow-up consultation in 2021 were sent a 32-point self-complete paper-based survey. Data were analysed using descriptive, parametric and non-parametric statistical analysis. This paper followed the Checklist for Reporting of Survey Studies (CROSS). RESULTS Of the 414 surveys returned (45% response rate), the acceptance for radiation oncology shared cancer follow-up care was high (80%). Patients treated with only radiotherapy were 1.7 times more likely to accept shared follow-up care than those treated with multiple modalities. Patients who preferred follow-up care for fewer than three years were 7.5 times more likely to accept shared care than those who preferred follow-up care for five years. Patients who travelled more than 20 minutes to their radiation oncologist or to the rural cancer centre were slightly more likely to accept shared care than those who travelled less than twenty minutes to the regional cancer centre. A high understanding of shared care (Intervention Coherence) and a positive feeling towards shared care (Affective Attitude) were significant predictive factors in accepting shared radiation oncology follow-up care. CONCLUSION Health services need to ensure patient preferences are considered to provide patient-centred cancer follow-up care. Shared cancer follow-up care implementation should start with patients who prefer a shorter follow-up period and understand the benefits of shared care. However, patients' involvement needs to be considered alongside other clinical risk profiles and organisational factors. Future qualitative research using the TFA constructs is warranted to inform clinical practice change.
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Affiliation(s)
- Tiffany Sandell
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Cancer Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
| | - Heike Schütze
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Andrew Miller
- Cancer Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Rowena Ivers
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Drabarek D, Habgood E, Ackermann D, Hersch J, Janda M, Morton RL, Guitera P, Soyer HP, Collgros H, Cust AE, Saw RP, Emery J, Mar V, Dieng M, Azzi A, Lilleyman A, Bell KJ. Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study. JMIR DERMATOLOGY 2022; 5:e40623. [PMID: 37632906 PMCID: PMC10334935 DOI: 10.2196/40623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/24/2022] [Accepted: 11/19/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The growing number of melanoma patients who need long-term surveillance increasingly exceeds the capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to perform skin self-examination and send dermoscopic images of lesions of concern to a dermatologist (mobile teledermoscopy) are a potential solution. If these technologies and the remote delivery of melanoma surveillance are to be incorporated into routine clinical practice, they need to be accepted by clinicians providing melanoma care, such as dermatologists and general practitioners (GPs). OBJECTIVE This study aimed to explore perceptions of potential benefits and harms of mobile teledermoscopy, as well as experiences with this technology, among clinicians participating in a pilot randomized controlled trial (RCT) of patient-led melanoma surveillance. METHODS This qualitative study was nested within a pilot RCT conducted at dermatologist and skin specialist GP-led melanoma clinics in New South Wales, Australia. We conducted semistructured interviews with 8 of the total 11 clinicians who were involved in the trial, including 4 dermatologists (3 provided teledermatology, 2 were treating clinicians), 1 surgical oncologist, and 3 GPs with qualifications in skin cancer screening (the remaining 3 GPs declined an interview). Thematic analysis was used to analyze the data with reference to the concepts of "medical overuse" and "high-value care." RESULTS Clinicians identified several potential benefits, including increased access to dermatology services, earlier detection of melanomas, reassurance for patients between scheduled visits, and a reduction in unnecessary clinic visits. However, they also identified some potential concerns regarding the use of the technology and remote monitoring that could result in diagnostic uncertainty. These included poor image quality, difficulty making assessments from a 2D digital image (even if good quality), insufficient clinical history provided, and concern that suspicious lesions may have been missed by the patient. Clinicians thought that uncertainty arising from these concerns, together with perceived potential medicolegal consequences from missing a diagnosis, might lead to increases in unnecessary clinic visits and procedures. Strategies suggested for achieving high-value care included managing clinical uncertainty to decrease the potential for medical overuse and ensuring optimal placement of patient-led teledermoscopy within existing clinical care pathways to increase the potential for benefits. CONCLUSIONS Clinicians were enthusiastic about the potential and experienced benefits of mobile teledermoscopy; however, managing clinical uncertainty will be necessary to achieve these benefits in clinical care outside of trial contexts and minimize potential harms from medical overuse. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12616001716459; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865.
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Affiliation(s)
- Dorothy Drabarek
- School of Public Health, University of Sydney, Sydney, Australia
| | - Emily Habgood
- Centre for Cancer Research, Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Deonna Ackermann
- School of Public Health, University of Sydney, Sydney, Australia
| | - Jolyn Hersch
- School of Public Health, University of Sydney, Sydney, Australia
| | - Monika Janda
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Rachael L Morton
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - H Peter Soyer
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Helena Collgros
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Anne E Cust
- School of Public Health, University of Sydney, Sydney, Australia
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
- The Daffodil Centre, University of Sydney, Sydney, Australia
| | - Robyn Pm Saw
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Melanoma Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jon Emery
- Centre for Cancer Research, Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Victoria Mar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mbathio Dieng
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | | | - Katy Jl Bell
- School of Public Health, University of Sydney, Sydney, Australia
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Sandell T, Schütze H. Factors influencing the translation of shared cancer follow-up care into clinical practice: a systematic review. BMJ Open 2022; 12:e055460. [PMID: 36038175 PMCID: PMC9438010 DOI: 10.1136/bmjopen-2021-055460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care and the need to find alternative models of care. Shared cancer follow-up care in general practice is a safe option in terms of quality of life and cancer recurrence; however, there are barriers to translating this into practice. This review aimed to identify factors that influence the translation of shared cancer follow-up care into clinical practice. METHODS Systematic review. Seven electronic databases: MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psychinfo, Health Source: Nursing/Academic Edition and Psychology and Behavioural Sciences Collection, were searched for published papers between January 1999 and December 2021. The narrative review included papers if they were available in full-text, English, peer-reviewed and focused on shared cancer follow-up care. RESULTS Thirty-eight papers were included in the final review. Five main themes emerged: (1) reciprocal clinical information sharing is needed between oncologists and general practitioners, and needs to be timely and relevant; (2) responsibility of care should be shared with the oncologist overseeing care; (3) general practitioners skills and knowledge to provide cancer follow-up care; (4) need for clinical management guidelines and rapid referral to support general practitioners to provide shared follow-up care and (5) continuity of care and satisfaction of care is vital for shared care. CONCLUSION The acceptability of shared cancer follow-up care is increasing. Several barriers still exist to translating this into practice. Work is required to develop a shared-care model that can support general practitioners, while the oncologist can oversee the care and implement two-way communication between general and oncologists' clinics. The move towards integrating electronic healthcare records and web-based platforms for information exchange provides a promise to the timely exchange of information. PROSPERO REGISTRATION NUMBER CRD42020191538.
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Affiliation(s)
- Tiffany Sandell
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Radiation Oncology, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Heike Schütze
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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GPs' involvement in diagnosing, treating, and referring patients with suspected or confirmed primary cutaneous melanoma: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101028. [PMID: 32295791 PMCID: PMC7330208 DOI: 10.3399/bjgpopen20x101028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background In Australia, melanoma is managed in primary and secondary care settings. An individual concerned about a suspicious lesion typically presents first to their GP. Aim To identify factors influencing GPs’ decisions to diagnose, treat, or refer patients with suspected melanoma. Design & setting Semi-structured interviews were undertaken with 23 GPs working in general practice or skin cancer clinics in Australia. Method The semi-structured interviews were audio-recorded, de-identified, and professionally transcribed. Thematic analysis was used to analyse the data. Results Considerable variation existed in GPs’ self-reported confidence and involvement in melanoma management. Multiple factors were identified as influencing GPs’ decisions to diagnose, treat, or refer patients with suspected or confirmed melanoma. Health system level factors included the overlapping roles of GPs and specialists, and access to and/or availability of specialists. Practice level factors included opportunities for formal and informal training, and having a GP with a special interest in skin cancer within their practice. GP and patient level factors included the GP’s clinical interests, the clinical features (for example, site and size) and histopathology of the suspected melanoma, eligibility for possible sentinel lymph node biopsy, and patient preferences. For some GPs, concerns over misdiagnosis and the option of referring patients at any stage in the melanoma management continuum appeared to affect their interest and confidence in melanoma management. Conclusion GP involvement in melanoma patient care can extend well beyond cancer screening, prevention and supportive care roles to include provision of definitive melanoma patient management. GPs with an interest in being involved in melanoma management should be encouraged and supported to develop the skills needed to manage these patients, and to refer when appropriate.
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Zhang S, McClanahan D, Khosravi H, Ferris LK. Screening and Managing Melanoma: Who Is (Should Be) Doing It? CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nijhuis AAG, Dieng M, Khanna N, Lord SJ, Dalton J, Menzies AM, Turner RM, Allen J, Saw RPM, Nieweg OE, Thompson JF, Morton RL. False-Positive Results and Incidental Findings with Annual CT or PET/CT Surveillance in Asymptomatic Patients with Resected Stage III Melanoma. Ann Surg Oncol 2019; 26:1860-1868. [DOI: 10.1245/s10434-019-07311-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 11/18/2022]
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Lim WY, Turner RM, Morton RL, Jenkins MC, Irwig L, Webster AC, Dieng M, Saw RPM, Guitera P, Low D, Low C, Bell KJL. Use of shared care and routine tests in follow-up after treatment for localised cutaneous melanoma. BMC Health Serv Res 2018; 18:477. [PMID: 29925350 PMCID: PMC6011416 DOI: 10.1186/s12913-018-3291-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients may decide to undertake shared care with a general practitioner (GP) during follow-up after treatment for localised melanoma. Routine imaging tests for surveillance may be commonly used despite no evidence of clinical utility. This study describes the frequency of shared care and routine tests during follow-up after treatment for localised melanoma. METHODS We randomly sampled 351 people with localised melanoma [American Joint Cancer Committee (AJCC) substages 0 - II] who had not had recurrent or new primary melanoma diagnosed from a total of 902 people diagnosed and treated for localised melanoma at a specialist centre in 2014. We interviewed participants by telephone about their experience of follow-up in the past year, and documented the proportion of patients who were undertaking shared care follow-up with a GP. We also recorded the frequency and type of investigations during follow-up. We calculated weighted estimates that are representative of the full inception cohort. RESULTS Of the 351 people who were invited to participate, 230 (66%) people consented to the telephone interview. The majority undertook shared care follow-up with a GP (61%). People who choose to have shared care follow-up with a GP are more likely to be male (p = 0.006), have lower AJCC stage (p for trend = 0.02), reside in more remote areas (p for trend< 0.001), and are less likely to have completed secondary school (p < 0.001). Few people saw a non-doctor health practitioner as part of their follow-up (9%). Many people report undergoing tests for melanoma, much of which may be routine tests for surveillance (37%). CONCLUSIONS The majority of people treated for a first primary localised melanoma at a specialist centre, without recurrent or new melanoma, choose to undertake shared care follow-up with a GP. Many appear to have routine diagnostic imaging as part of their melanoma surveillance.
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Affiliation(s)
- Wei-Yin Lim
- Clinical Research Centre Perak, Ministry of Health Malaysia, Ipoh, Perak Malaysia
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Robin M. Turner
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia
| | - Marisa C. Jenkins
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Angela C. Webster
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Mbathio Dieng
- School of Public Health, The University of Sydney, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia
| | - Robyn P. M. Saw
- Melanoma Institute Australia, Sydney, NSW Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW Australia
- Division of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Pascale Guitera
- Melanoma Institute Australia, Sydney, NSW Australia
- Discipline of Dermatology, The University of Sydney, Sydney, NSW Australia
- The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Donald Low
- Cancer Voices NSW, Sydney, NSW Australia
| | | | - Katy J. L. Bell
- School of Public Health, The University of Sydney, Sydney, NSW Australia
- Centre for Evidence Based Practice, Bond University, Gold Coast, QLD Australia
- The University of Sydney, Rm 333 Edward Ford Building (A27), Sydney, NSW 2006 Australia
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Read RL, Madronio CM, Cust AE, Goumas C, Watts CG, Menzies S, Curtin AM, Mann G, Thompson JF, Morton RL. Follow-Up Recommendations after Diagnosis of Primary Cutaneous Melanoma: A Population-Based Study in New South Wales, Australia. Ann Surg Oncol 2018; 25:617-625. [PMID: 29299710 DOI: 10.1245/s10434-017-6319-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 12/17/2023]
Abstract
BACKGROUND Follow-up practices after diagnosis and treatment of primary cutaneous melanoma vary considerably. We aimed to determine factors associated with recommendations for follow-up setting, frequency, skin surveillance, and concordance with clinical guidelines. METHODS The population-based Melanoma Patterns of Care study documented clinicians' recommendations for follow-up for 2148 patients diagnosed with primary cutaneous melanoma over a 12-month period (2006/2007) in New South Wales, Australia. Multivariate log binomial regression models adjusted for patient and lesion characteristics were used to examine factors associated with follow-up practices. RESULTS Of 2158 melanomas, Breslow thickness was < 1 mm for 57% and ≥ 1 mm for 30%, while in situ melanomas accounted for 13%. Follow-up was recommended for 2063 patients (96%). On multivariate analysis, factors associated with a recommendation for follow-up at a specialist center were Breslow thickness ≥ 1 mm [prevalence ratio (PR) 1.05, 95% confidence interval (CI) 1.01-1.09] and initial treatment at a specialist center (PR 1.12, 95% CI 1.08-1.16). Longer follow-up intervals of > 3 months were more likely to be recommended for females, less likely for people living in rural compared with urban areas, and less likely for thicker (≥ 1 mm) melanomas compared with in situ melanomas. Skin self-examination was encouraged in 84% of consultations and was less likely to be recommended for patients ≥ 70 years (PR 0.88, 95% CI 0.84-0.93) and for those with thicker (≥ 1 mm) melanomas (PR 0.92, 95% CI 0.86-0.99). Only 1% of patients were referred for psychological care. CONCLUSIONS Follow-up recommendations were generally consistent with Australian national guidelines for management of melanoma, however some variations could be targeted to improve patient outcomes.
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Affiliation(s)
- Rebecca L Read
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Calvary Health Care, Bruce, ACT, Australia
| | - Christine M Madronio
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Chris Goumas
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Caroline G Watts
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Scott Menzies
- Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Austin M Curtin
- Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Graham Mann
- Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.
- NHMRC Clinical Trials Centre, The University of Sydney, Level 6, Medical Foundation Building92-94 Parramatta Road, Camperdown, NSW, Australia.
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Engler J, Kone I, Holmberg C, Baumann W, Siebenhofer A, Güthlin C. Oncologists' views on the importance of general practitioners for cancer patients: a qualitative interview study from Germany. Fam Pract 2017; 34:730-734. [PMID: 28486693 DOI: 10.1093/fampra/cmx044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Integrated cancer care requires cooperation between specialists and general practitioners (GPs). Mutual understanding of each other's tasks and responsibilities is essential if cooperation is to be successful. While GPs' opinions about oncologists have been addressed in previous studies, less is known about oncologists' views on the role of GPs' in cancer care, especially with regard to GPs' patient-centred, communication-based tasks. OBJECTIVE To assess oncologists' views on the importance of GPs for cancer patients. METHODS We conducted 15 qualitative guideline-based telephone interviews with oncologists using open-ended questions and analysed these interviews using thematic analysis. RESULTS Oncologists situated GPs as persons of trust for patients in a rather amicable sphere of caring in contrast to themselves who were situated in a rather biomedical sphere of evidence-based treatment decisions. Oncologists' appraisal of an overlapping of these spheres varied: While most stressed opportunities for patients (and themselves), others also mentioned risks. CONCLUSION Our analysis found that oncologists clearly distinguish between their own sphere of evidence-based treatment decision-making and GPs' sphere of psychosocial caring. The question remains how these roles get interconnected in real life situations in order to meet patients' needs adequately. So far it seems that it is often the patient who is travelling between both spheres and needs to initiate interconnection to get comprehensive cancer care.
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Affiliation(s)
- Jennifer Engler
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Insa Kone
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany.,Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Christine Holmberg
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Walter Baumann
- Scientific Institute of Office-Based Hematologists and Oncologists, Cologne, Germany
| | - Andrea Siebenhofer
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany.,Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Corina Güthlin
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
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Smit A, Keogh L, Newson A, Butow P, Dunlop K, Morton R, Kirk J, Espinoza D, Cust A. Does personalized melanoma genomic risk information trigger conversations about skin cancer prevention and skin examination with family, friends and health professionals? Br J Dermatol 2017. [DOI: 10.1111/bjd.15744] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A.K. Smit
- Cancer Epidemiology and Prevention Research Sydney School of Public Health The University of Sydney Australia
- Centre for Values Ethics and the Law in Medicine Sydney School of Public Health The University of Sydney Australia
| | - L.A. Keogh
- Melbourne School of Population and Global Health The University of Melbourne Australia
| | - A.J. Newson
- Centre for Values Ethics and the Law in Medicine Sydney School of Public Health The University of Sydney Australia
| | - P.N. Butow
- Centre for Medical Psychology and Evidence‐based Decision‐making School of Psychology The University of Sydney Australia
| | - K. Dunlop
- The Centre for Genetics Education NSW Health Sydney Australia
| | - R.L. Morton
- NHMRC Clinical Trials Centre The University of Sydney Australia
- Melanoma Institute Australia The University of Sydney Australia
| | - J. Kirk
- Westmead Clinical School and Westmead Institute for Medical Research Sydney Medical School The University of Sydney Australia
| | - D. Espinoza
- NHMRC Clinical Trials Centre The University of Sydney Australia
| | - A.E. Cust
- Cancer Epidemiology and Prevention Research Sydney School of Public Health The University of Sydney Australia
- Melanoma Institute Australia The University of Sydney Australia
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von Schuckmann LA, Smithers BM, Khosrotehrani K, Beesley VL, van der Pols JC, Hughes MB, Green AC. Use of support services in a sample of patients with high-risk primary melanomas in urban, regional and rural Queensland. Aust N Z J Public Health 2017; 41:315-319. [DOI: 10.1111/1753-6405.12662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/01/2016] [Accepted: 01/01/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lena A. von Schuckmann
- School of Public Health; The University of Queensland
- QIMR Berghofer Institute of Medical Research; Queensland
| | - Bernhard M. Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital; The University of Queensland
| | | | | | - Jolieke C. van der Pols
- School of Public Health; The University of Queensland
- QIMR Berghofer Institute of Medical Research; Queensland
| | | | - Adele C. Green
- QIMR Berghofer Institute of Medical Research; Queensland
- CRUK Manchester Institute and Institute of Inflammation and Repair; University of Manchester; UK
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12
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Dossett LA, Hudson JN, Morris AM, Lee MC, Roetzheim RG, Fetters MD, Quinn GP. The primary care provider (PCP)-cancer specialist relationship: A systematic review and mixed-methods meta-synthesis. CA Cancer J Clin 2017; 67:156-169. [PMID: 27727446 PMCID: PMC5342924 DOI: 10.3322/caac.21385] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Although they are critical to models of coordinated care, the relationship and communication between primary care providers (PCPs) and cancer specialists throughout the cancer continuum are poorly understood. By using predefined search terms, the authors conducted a systematic review of the literature in 3 databases to examine the relationship and communication between PCPs and cancer specialists. Among 301 articles identified, 35 met all inclusion criteria and were reviewed in-depth. Findings from qualitative, quantitative, and disaggregated mixed-methods studies were integrated using meta-synthesis. Six themes were identified and incorporated into a preliminary conceptual model of the PCP-cancer specialist relationship: 1) poor and delayed communication between PCPs and cancer specialists, 2) cancer specialists' endorsement of a specialist-based model of care, 3) PCPs' belief that they play an important role in the cancer continuum, 4) PCPs' willingness to participate in the cancer continuum, 5) cancer specialists' and PCPs' uncertainty regarding the PCP's oncology knowledge/experience, and 6) discrepancies between PCPs and cancer specialists regarding roles. These data indicate a pervasive need for improved communication, delineation, and coordination of responsibilities between PCPs and cancer specialists. Future interventions aimed at these deficiencies may improve patient and physician satisfaction and cancer care coordination. CA Cancer J Clin 2017;67:156-169. © 2016 American Cancer Society.
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Affiliation(s)
- Lesly A Dossett
- Assistant Professor, Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Janella N Hudson
- Postdoctoral Fellow, Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Arden M Morris
- Associate Professor, Department of Surgery and Center for Health Outcomes and Policy, University of Michigan Health System, Ann Arbor, MI
| | - M Catherine Lee
- Associate Member, Comprehensive Breast Program, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Richard G Roetzheim
- Professor, Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL
- Senior Member, Department of Health Outcomes and Behavior and Comprehensive Breast Program, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Michael D Fetters
- Professor, Department of Family Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Gwendolyn P Quinn
- Senior Member, Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, Tampa, FL
- Professor, Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
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Murchie P, Allan JL, Brant W, Dennis M, Hall S, Masthoff J, Walter FM, Johnston M. Total skin self-examination at home for people treated for cutaneous melanoma: development and pilot of a digital intervention. BMJ Open 2015; 5:e007993. [PMID: 26251412 PMCID: PMC4538247 DOI: 10.1136/bmjopen-2015-007993] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To develop a digital intervention to prompt, support, and respond to the outcomes of total skin self-examinations (TSSEs) at home by people treated for cutaneous melanoma. DESIGN A complex intervention development study. SETTING Northeast Scotland. PARTICIPANTS Semistructured scoping interviews; people previously treated for cutaneous melanoma (n=21). Pilot testing: people treated for melanoma stages 0-2C (n=20); general practitioners (n=6); and a nurse specialist in dermatology (n=1). INTERVENTION A tablet-based digital intervention designed to prompt and support TSSEs comprising instructional videos and electronic reporting (including photographs) to a clinical nurse specialist in dermatology, with subsequent clinical triage. PRIMARY AND SECONDARY OUTCOME MEASURES Qualitative assessment of intervention feasibility and acceptability, and quantitative assessment of intentions and confidence to perform TSSEs in pilot participants. RESULTS The majority of pilot participants were strongly positive and adhered well to the intervention (n=15), with 7 of these reporting symptoms of concern at some point during the 6-month pilot. 4 patients complied intermittently, 3 reporting skin problems at least once during the pilot, and 1 withdrew. 2 patients underwent skin surgery as a result of participating in the pilot, with 1 diagnosed as having a recurrent melanoma and the other, a benign lesion. A number of practical issues to improve the usability of the intervention were identified. The proportion of participants reporting intention to check their skin at least monthly increased during the intervention as did confidence to conduct a skin check. CONCLUSIONS People previously treated for cutaneous melanoma are prepared to use digital technology to support them in conducting TSSE. An intervention has been developed which is practical, effective and safe, and after addressing minor practical issues, could now be evaluated for clinical outcomes in a randomised clinical trial.
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Affiliation(s)
- Peter Murchie
- Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Julia L Allan
- Aberdeen Health Psychology Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Matthew Dennis
- dot.rural Digital Economy Hub, University of Aberdeen, King's College, Aberdeen, UK
| | - Susan Hall
- Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Judith Masthoff
- Department of Computing Science, University of Aberdeen, King's College, Aberdeen, UK
| | - Fiona M Walter
- Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, UK
| | - Marie Johnston
- Aberdeen Health Psychology Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Burau V, Bro F. The making of local hospital discharge arrangements: specifying the role of professional groups. BMC Health Serv Res 2015; 15:305. [PMID: 26238863 PMCID: PMC4524021 DOI: 10.1186/s12913-015-0963-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Timely discharge is a key component of contemporary hospital governance and raises questions about how to move to more explicit discharge arrangements. Although associated organisational changes closely intersect with professional interests, there are relatively few studies in the literature on hospital discharge that explicitly examine the role of professional groups. Recent contributions to the literature on organisational studies of the professions help to specify how professional groups in hospitals contribute to the introduction and routinisation of discharge arrangements. This study builds on a view of organisational and professional projects as closely intertwined, where professionals take up organising roles and where organisations shape professionalism. METHODS The analysis is based on a case study of the introduction and routinisation of explicit discharge arrangements for patients with prostate cancer in two hospitals in Denmark. This represents a typical case that involves changes in professional practice without being first and foremost a professional project. The multiple case design also makes the findings more robust. The analysis draws from 12 focus groups with doctors, nurses and secretaries conducted at two different stages in the process of the making of the local discharge arrangements. RESULTS From the analysis, two distinct local models of discharge arrangements that connect more or less directly to existing professional practice emerge: an 'add-on' model, which relies on extra resources, special activities and enforced change; and an 'embedded model', which builds on existing ways of working, current resources, and perspectives of professional groups. The two models reveal differences in the roles of professional groups in terms of their stakes and involvement in the process of organisational change: whereas in the 'add on' model the professional groups remain at a distance, in the 'embedded model' they are closely engaged. CONCLUSIONS In terms of understanding the making of hospital discharge arrangements, the study contributes two sets of insights into the specific roles of professional groups. First, professional interests are an important driver for health professionals to engage in adapting discharge arrangements; and second, professional practice offers a powerful lever for turning new discharge arrangements into organisational routines.
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Affiliation(s)
- Viola Burau
- CFK - Public Health and Quality Improvement, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
- Department of Political Science, Aarhus University, Aarhus N, Denmark.
| | - Flemming Bro
- Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
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15
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Memari N, Hayen A, Bell KJL, Rychetnik L, Morton RL, McCaffery K, Thompson JF, Irwig L, Turner RM. How Often Do Patients with Localized Melanoma Attend Follow-Up at a Specialist Center? Ann Surg Oncol 2015; 22 Suppl 3:S1164-71. [PMID: 25963479 DOI: 10.1245/s10434-015-4589-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Post-treatment follow-up for patients with American Joint Committee on Cancer (AJCC) stage I/II melanoma is believed to be important for early detection of disease recurrence and new primary melanomas, but comes with costs to both patients and healthcare providers. We aimed to determine how frequently a cohort of patients attended follow-up after surgical treatment at one Specialist Center. METHODS We used prospectively collected data from the Melanoma Institute Australia (MIA) for patients with AJCC stage I/II melanoma diagnosed between January 2008 and December 2011. The distribution of the number of recorded follow-up visits per patient was analyzed and compared with the number of follow-up visits recommended in the 2008 Australian and New Zealand Melanoma Management Guidelines. RESULTS A total of 3813 patients with stage I/II melanoma were identified. During the first year of follow-up post-surgery, 34 % of stage I patients and 14 % of stage II patients had the number of follow-up visits recommended in the guidelines. A large proportion of melanoma patients did not appear to be routinely followed up at MIA, with 43.2 % of stage I patients and 28.7 % of stage II patients having either no visit or only one visit post-surgery. During all years of follow-up, 13.2 % of stage I patients and 4.1 % of stage II patients had the number of follow-up visits at the specialist center as recommended in the guidelines. CONCLUSIONS The large proportion of patients who had fewer follow-up visits than expected suggests (i) many patients are followed up in clinics elsewhere, and/or (ii) post-surgical surveillance is less frequent in practice.
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Affiliation(s)
- Niloofar Memari
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Katy J L Bell
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Rachael L Morton
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Robin M Turner
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
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17
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Carter D, Afzali HHA, Street J, Bessen T, Neuhaus S. Melanoma follow up: time to generate the evidence. AUST HEALTH REV 2013; 37:501-3. [DOI: 10.1071/ah13096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 07/02/2013] [Indexed: 11/23/2022]
Abstract
Research is needed into current melanoma follow-up practices and their implications for patients and society. We highlight the need and suggest a way forward.
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