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Liemburg GB, Korevaar JC, Logtenberg M, Berendsen AJ, Berger MY, Brandenbarg D. Cancer follow-up in primary care after treatment with curative intent: Views of patients with breast and colorectal cancer. PATIENT EDUCATION AND COUNSELING 2024; 122:108139. [PMID: 38232673 DOI: 10.1016/j.pec.2024.108139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Increased cancer survival leads to more patients requiring oncological follow-up. Debate about how best to coordinate this care has led to the proposed involvement of general practitioners (GPs) rather than continued reliance on hospital care. However, we still require patient opinions to inform this debate. METHODS This qualitative interview study explored opinions about organization of follow-up care of patients treated curatively for breast and colorectal cancer. Thematic analysis was applied. RESULTS We interviewed 29 patients and identified three themes concerning care substitution: "benefits and barriers," "requirements," and "suitable patient groups." Benefits included accessibility, continuity, contextual knowledge, and psychosocial support. Barriers included concerns about cancer-specific expertise of GPs and longer waiting times. Requirements were sufficient time and remuneration, sufficient training, clear protocols, and shared-care including efficient communication with specialists. CONCLUSIONS According to patients with cancer, formal GP involvement appears feasible, although important barriers must be overcome before instituting care substitution. A possible solution are personalized follow-up plans based on three-way conversations with the specialist and the GP after the initial hospital care. PRACTICE IMPLICATIONS With adequate training, time, and remuneration, formal GP involvement could ensure more comprehensive care, possibly starting with less complex cases.
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Affiliation(s)
- Geertje B Liemburg
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Joke C Korevaar
- NIVEL Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Mariëlle Logtenberg
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annette J Berendsen
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolein Y Berger
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daan Brandenbarg
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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2
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Vos JAM, El Alili M, Duineveld LAM, Wieldraaijer T, Wind J, Sert E, Donkervoort SC, Govaert MJPM, van Geloven NAW, van de Ven AWH, Heuff G, van Weert HCPM, Bosmans JE, van Asselt KM. Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial. J Cancer Surviv 2023:10.1007/s11764-023-01383-4. [PMID: 37097550 DOI: 10.1007/s11764-023-01383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The aim of this study is to assess cost-effectiveness of general practitioner (GP) versus surgeon-led colon cancer survivorship care from a societal perspective. METHODS We performed an economic evaluation alongside the I CARE study, which included 303 cancer patients (stages I-III) who were randomised to survivorship care by a GP or surgeon. Questionnaires were administered at baseline, 3-, 6-, 12-, 24- and 36-months. Costs included healthcare costs (measured by iMTA MCQ) and lost productivity costs (SF-HLQ). Disease-specific quality of life (QoL) was measured using EORTC QLQ-C30 summary score and general QoL using EQ-5D-3L quality-adjusted life years (QALYs). Missing data were imputed. Incremental cost-effectiveness ratios (ICERs) were calculated to relate costs to effects on QoL. Statistical uncertainty was estimated using bootstrapping. RESULTS Total societal costs of GP-led care were significantly lower compared to surgeon-led care (mean difference of - €3895; 95% CI - €6113; - €1712). Lost productivity was the main contributor to the difference in societal costs (- €3305; 95% CI - €5028; - €1739). The difference in QLQ-C30 summary score over time between groups was 1.33 (95% CI - 0.049; 3.15). The ICER for QLQ-C30 was - 2073, indicating that GP-led care is dominant over surgeon-led care. The difference in QALYs was - 0.021 (95% CI - 0.083; 0.040) resulting in an ICER of 129,164. CONCLUSIONS GP-led care is likely to be cost-effective for disease-specific QoL, but not for general QoL. IMPLICATIONS FOR CANCER SURVIVORS With a growing number of cancer survivors, GP-led survivorship care could help to alleviate some of the burden on more expensive secondary healthcare services.
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Affiliation(s)
- Julien A M Vos
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Mohamed El Alili
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Van Der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Laura A M Duineveld
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Thijs Wieldraaijer
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jan Wind
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Edanur Sert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Sandra C Donkervoort
- Department of Surgery, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, the Netherlands
| | - Marc J P M Govaert
- Department of Surgery, Dijklander Hospital, Maelsonstraat 3, 1624 NP, Hoorn, the Netherlands
| | - Nanette A W van Geloven
- Department of Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Anthony W H van de Ven
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands
| | - Gijsbert Heuff
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Van Der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Kristel M van Asselt
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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3
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Follow-up of curatively treated cancer in primary care: a qualitative study of the views of Dutch GPs. Br J Gen Pract 2022; 72:e592-e600. [PMID: 35817587 PMCID: PMC9282806 DOI: 10.3399/bjgp.2021.0519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Follow-up for cancer typically occurs in secondary care, and improved survival has increased demands on these services. Other care models may alleviate this burden, such as moving (parts of) follow-up care for curatively treated patients from secondary to primary care (care substitution). Aim To explore the opinions of GPs regarding the potential benefits, barriers, and requirements of care substitution for breast and colorectal cancer. Design and setting A qualitative study of the opinions of purposively sampled GPs in Dutch primary care. Method Focus group sessions and individual semi-structured interviews were recorded and transcribed verbatim. Data were analysed by two independent researchers using thematic analysis. Results Two focus groups (n = 14) were conducted followed by nine individual interviews. Three main themes were identified: perceived benefits, perceived barriers, and perceived requirements. Perceived benefits included better accessibility and continuity of care, and care closer to patients’ homes. Uncertainty about cancer-related competences and practical objections were perceived as barriers. Requirements included close specialist collaboration, support from patients for this change, and stepwise implementation to avoid loss of existing care quality. Conclusion Most GPs reported that they were not in favour of complete care substitution, but that primary care could have greater formal involvement in oncological follow-up if there is close collaboration with secondary care (that is, shared care), support from patients, sufficient resource allocation, stepwise implementation with clear guidelines, and monitoring of quality. Clear and broadly supported protocols need to be developed and tested before implementing follow-up in primary care.
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Beermann LC, Alexanderson K, Chen L. Healthcare use, sickness absence, and disability pension among colorectal cancer survivors and population references in Sweden. Acta Oncol 2021; 60:1643-1650. [PMID: 34514940 DOI: 10.1080/0284186x.2021.1974551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) has negative long-term impacts on survivors' health and work capacity. We aimed to investigate specialized healthcare use and sickness absence and disability pension among CRC survivors and matched references. MATERIAL AND METHODS In this longitudinal register-based cohort study, 6679 patients with a first primary CRC in 2008-2011 (when aged 18-62) and 26,716 CRC-free matched references were followed from 2 years before up to 5 years after diagnosis date. Mean numbers of hospital days and outpatient visits were illustrated for survivors and references for the 7-year period. Crude and adjusted mean numbers of sickness absence/disability pension net days were calculated for post-diagnosis Years 3 and 5. RESULTS Survivors' healthcare use was higher compared to their references throughout the 7 years around CRC diagnosis and was mostly due to CRC, secondary neoplasms, and digestive disorders. In Year 5, survivors had 1.94 mean outpatient visits and 2.13 mean inpatient days (compared to 1.00 and 0.82 for references, respectively). Survivors' adjusted mean sickness absence/disability pension days amounted to 85 d in Year 3 and 77 in Year 5 (compared to 57 and 54 d in the references). Higher mean number of future days was found among women, lower-educated, foreign-born, with previous comorbidities or previous mental disorders. Those with many sickness absence days in 2 years pre-diagnosis had the highest number of future sickness absence/disability pension days. CONCLUSIONS Post-diagnostic healthcare use remained high among CRC survivors, mostly due to cancer (CRC and other neoplasms) and digestive diagnoses. Their sickness absence and disability pension decreased gradually over the period but remained higher than among references. Pre-morbid characteristics may be used in early work-related clinical planning for the survivors.
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Affiliation(s)
- Luisa Christine Beermann
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lingjing Chen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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5
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Wollersheim BM, van Eenbergen M, van Asselt KM, Fossion LMCL, Koldewijn EL, Oddens JR, Oomens EH, Wijsman BP, van de Poll-Franse LV, Ezendam NPM. Type of treatment, symptoms and patient satisfaction play an important role in primary care contact during prostate cancer follow-up: results from the population-based PROFILES registry. BMC FAMILY PRACTICE 2021; 22:218. [PMID: 34736413 PMCID: PMC8569955 DOI: 10.1186/s12875-021-01567-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND With the increasing attention for the role of General Practitioners (GPs) after cancer treatment, it is important to better understand the involvement of GPs following prostate cancer treatment. This study investigates factors associated with GP contact during follow-up of prostate cancer survivors, such as patient, treatment and symptom variables, and satisfaction with, trust in, and appraised knowledge of GPs. METHODS Of 787 prostate cancer survivors diagnosed between 2007 and 2013, and selected from the Netherlands Cancer Registry, 557 (71%) responded to the invitation to complete a questionnaire. Multivariable logistic regression analyses were performed to investigate which variables were associated with GP contact during follow- up. RESULTS In total, 200 (42%) prostate cancer survivors had contact with their GP during follow-up, and 76 (16%) survivors preferred more contact. Survivors who had an intermediate versus low educational level (OR = 2.0) were more likely to have had contact with their GP during follow-up. Survivors treated with surgery (OR = 2.8) or hormonal therapy (OR = 3.5) were also more likely to seek follow-up care from their GP compared to survivors who were treated with active surveillance. Patient reported bowel symptoms (OR = 1.4), hormonal symptoms (OR = 1.4), use of incontinence aids (OR = 1.6), and being satisfied with their GP (OR = 9.5) were also significantly associated with GP contact during follow-up. CONCLUSIONS Education, treatment, symptoms and patient satisfaction were associated with GP contact during prostate cancer follow-up. These findings highlight the potential for adverse side-effects to be managed in primary care. In light of future changes in cancer care, evaluating prostate cancer follow-up in primary care remains important.
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Affiliation(s)
- Barbara M Wollersheim
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Mies van Eenbergen
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Kristel M van Asselt
- Department of General Practice, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jorg R Oddens
- Department of Urology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric H Oomens
- Department of Urology, Amphia Hospital, Breda, The Netherlands
| | - Bart P Wijsman
- Department of Urology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Lonneke V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Nicole P M Ezendam
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
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6
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Lamort-Bouché M, Chardon M, Kellou N, Ray-Coquard I, Colin C, Letrilliart L. Cancer screening and follow-up in general practice: A French nationwide cross-sectional study. Eur J Gen Pract 2021; 26:95-101. [PMID: 32674614 PMCID: PMC7470121 DOI: 10.1080/13814788.2020.1784875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The overall activity of general practitioners (GPs) related to cancer screening and follow-up is poorly documented. OBJECTIVES To describe cancer screening and follow-up activities carried out in general practice and analyse them according to the socio-economic characteristics of patients. METHODS We used data from a French nationwide, multicentre, cross-sectional study that described the distribution of health problems managed in general practice and the associated processes of care. Analyses were adjusted on age and gender when appropriate, using a multivariate, hierarchical, linear mixed-effects model. RESULTS Among 20,613 consultations recorded, 580 involved cancer screening (2.8%) and 475 cancer follow-ups (2.3%). The most frequent cancer screening procedures concerned colorectal cancer (38.6% of screening procedures), breast cancer (32.6%), cervical cancer (17.0%), and prostate cancer (9.3%). In consultations with female patients, the most frequent types of cancer followed up were breast (44.9%) and colorectal cancer (10.5%), and with male patients, the most frequent were prostate (37.3%) and skin cancer (10.3%). After adjustment on age and gender, consultations with cancer follow-up included a mean 1.9 health problems managed in addition to cancer. Consultations with cancer screening or follow-up issue less often involved a patient on low income than other consultations (2.4% vs. 4.2%, and 1.1% vs. 4.2%, respectively). CONCLUSION Around 5% of French general practice consultations include cancer screening or follow-up. Socio-economical inequalities demand further research.
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Affiliation(s)
- Marion Lamort-Bouché
- Université de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Unité mixte de recherche Epidémiologique et de Surveillance Transport Travail Environnement, Lyon, France
| | | | | | - Isabelle Ray-Coquard
- Département d'Oncologie Médicale, Centre Léon Bérard, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon, France
| | - Cyrille Colin
- Unité d'Evaluation Médico-Economique, Pôle Information Médicale Evaluation Recherche, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon, France
| | - Laurent Letrilliart
- Université de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon, France
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7
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Rasmussen LA, Jensen H, Falborg AZ, Iversen LH, Vedsted P. A nationwide register-study of healthcare utilisation in the year preceding a colorectal cancer recurrence diagnosis. Eur J Cancer Care (Engl) 2021; 30:e13494. [PMID: 34291857 DOI: 10.1111/ecc.13494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/19/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Linda Aagaard Rasmussen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
| | - Henry Jensen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
| | - Alina Zalounina Falborg
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
| | - Lene Hjerrild Iversen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Colorectal Cancer Group, Copenhagen, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
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8
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Cohen Castel O, Dagan E, Keinan-Boker L, Low M, Shadmi E. Patients' Perceived Continuity of Care and Adherence to Oral Anticancer Therapy: a Prospective Cohort Mediation Study. J Gen Intern Med 2021; 36:1525-1532. [PMID: 33768501 PMCID: PMC8175494 DOI: 10.1007/s11606-021-06704-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral anticancer therapy (OACT) poses adherence-related challenges to patients while generating a setting in which both primary care physicians (PCPs) and oncologists are involved in the active treatment of cancer. Continuity of care (COC) was shown to be associated with medication adherence. While maintaining COC is a central role of the PCP, how this affects continuity with oncologists, and jointly affects OACT adherence, is yet unknown. OBJECTIVES To explore how aspects of COC act together to promote OACT adherence. Specifically, to examine whether better personal continuity with the PCP leads to better personal continuity with the oncologist, which together lead to better cross-boundary continuity between the oncologist and the PCP, jointly leading to good adherence to OACT. DESIGN AND SETTING A prospective cohort study conducted in five oncology centers in Israel. A bootstrapping method was used to test the serial mediation model. PARTICIPANTS Adult patients (age > 18 years) receiving a first OACT prescription (n = 119) were followed for 120 days. MAIN MEASURES The Nijmegen Continuity Questionnaire was used to assess patients' perceived personal and cross-boundary continuity. The medication possession ratio was used to measure adherence. KEY RESULTS Better personal continuity with the PCP was associated with better personal continuity with the oncologist (B = 0.35, p < 0.001), which was associated with better cross-boundary continuity (B = 0.33, p < 0.001), which, in turn, was associated with good adherence to OACT (B = 0.46, p = 0.03). Additionally, the indirect effect of personal continuity with the PCP on adherence to OACT through the mediation of personal continuity with the oncologist and cross-boundary continuity was found to be statistically significant (B = 0.053, 95% CI 0.0006-0.17). CONCLUSIONS In a system where the PCP is the case manager, cancer patients' perceived personal continuity with the PCP has an essential role for initiating a sequence of care delivery events that positively affect OACT adherence.
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Affiliation(s)
- Orit Cohen Castel
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel.
| | - Efrat Dagan
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Marcelo Low
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Clalit Health Services, Head Office, Tel Aviv, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel
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9
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Is There Still a Role for Physical Consultation in Colorectal Cancer Surveillance? J Gastrointest Surg 2021; 25:290-292. [PMID: 32865732 PMCID: PMC7457892 DOI: 10.1007/s11605-020-04774-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/08/2020] [Indexed: 01/31/2023]
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10
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Prioritisation of treatment goals among older patients with non-curable cancer: the OPTion randomised controlled trial in Dutch primary care. Br J Gen Pract 2020; 70:e450-e456. [PMID: 32482626 DOI: 10.3399/bjgp20x710405] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/12/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Older patients with cancer often find it difficult to take part in shared decision making. AIM To assess the utility of the Outcome Prioritisation Tool (OPT), designed to aid discussion with a patient in regards to their treatment goals, to empower patients with cancer through structured conversations about generic treatment goals with GPs. DESIGN AND SETTING A randomised controlled trial of 114 Dutch participants recruited between November 2015 and January 2019, aged ≥60 years with non-curable cancer who had to make a treatment decision with an oncologist. The intervention group used the OPT while the control group received care as usual. METHOD The primary outcome was patient empowerment using the score on the decision self-efficacy (DSE) scale. Secondary outcomes were symptoms measures of fatigue, anxiety, and depression. The experiences of participants were also explored. RESULTS No effect was found on patient empowerment between the OPT group (n = 48; DSE 86.8; standard deviation [SD] = 18.2) and the control group (n = 58; DSE 84.2; SD = 17.6; P = 0.47). In the OPT group, although statistically non-significant, fewer patients had low empowerment (18.8%, n = 9 versus 24.1%, n = 14; P = 0.50), but they did have statistically significant lower mean anxiety scores (6.0, SD = 4.6 versus 7.6, SD = 4.4; P<0.05) and less mild fatigue (58.8%, n = 30 versus 77.2%, n = 44; P = 0.05). Overall, 44.8% (n = 13) of patients indicated that the OPT-facilitated conversation helped them make a treatment decision, and 31.1% (n = 14) of the GPs reported that they gained new insights from the conversation. CONCLUSION An OPT-facilitated conversation about generic treatment goals between patients and their GPs is associated with less anxiety and fatigue, but did not show statistically significant improvements in patient empowerment. Adding the OPT to routine care might ensure more patient-tailored care.
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11
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Duineveld LAM, Molthof H, Wieldraaijer T, van de Ven AWH, Busschers WB, van Weert HCPM, Wind J. General practitioners' involvement during survivorship care of colon cancer in the Netherlands: primary health care utilization during survivorship care of colon cancer, a prospective multicentre cohort study. Fam Pract 2019; 36:765-770. [PMID: 31204434 PMCID: PMC7006992 DOI: 10.1093/fampra/cmz028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Primary health care use increases when cancer is diagnosed. This increase continues after cancer treatment. More generalist care is suggested to improve survivorship care. It is unknown to what extent cancer-related symptoms are currently presented in primary care in this survivorship phase. OBJECTIVE To analyse primary health care utilization of colon cancer patients during and after treatment with curative intent. METHODS In a prospective multicentre cohort study among patients with curatively treated colon cancer, we describe the primary health care utilization during the first 5 years of follow-up. Data were collected at general practitioner (GP) practices during 6 months. RESULTS Of 183 included participants, 153 (84%) consulted their GP resulting in 606 contacts (mean 3.3, standard deviation 3.01) with on average 0.9 contact for colon-cancer-related (CCR) problems in the 6-month study period. Median time after surgery at inclusion was 7.6 months (range 0-58). Abdominal pain and chemotherapy-related problems were the most frequently reported CCR reasons. Of the CCR contacts, 83% was managed in primary care. As time after surgery passed, the number of CCR contacts declined in patients without chemotherapy and remained constant in patients who received chemotherapy. CONCLUSION Colon cancer survivors contact their GP frequently also for reasons related to cancer. Currently, a formal role for GPs in survivorship care is lacking, but nevertheless GPs provide a substantial amount of care. Working agreements between primary and secondary care are necessary to formalize the GP's role in order to improve the quality of survivorship care.
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Affiliation(s)
- Laura A M Duineveld
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam
| | - Hanneke Molthof
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam
| | - Thijs Wieldraaijer
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam
| | - Anthony W H van de Ven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim B Busschers
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam
| | - Jan Wind
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam
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12
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Fidjeland HL, Vistad I, Gjelstad S, Brekke M. Exploring why patients with cancer consult GPs: a 1-year data extraction. BJGP Open 2019; 3:bjgpopen19X101663. [PMID: 31581120 PMCID: PMC6995854 DOI: 10.3399/bjgpopen19x101663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Survival rates of patients with cancer are increasing owing to improvements in diagnostics and therapies. The traditional hospital-based follow-up model faces challenges because of the consequent increasing workload, and it has been suggested that selected patients with cancer could be followed up by GPs.The hypothesis of the study was that, regardless of the hospital-based follow-up care, GPs see their patients with cancer both for cancer-related problems as well as for other reasons. Thus, a formalised follow-up by GPs would not mean too large a change in GPs' workloads. AIM To explore to what extent patients with cancer consult their GPs, and for what reasons. DESIGN & SETTING A 1-year explorative study was undertaken, based on data from 91 Norwegian GPs from 2016-2017. METHOD The data were electronically extracted from GPs' electronic medical records (EMR). RESULTS Data were collected from 91 GPs. There were 11 074 consultations in total, generated by 1932 patients with cancer. The mean consultation rate was higher among the patients with cancer compared with Norwegian patients in general. In one-third of the consultations, cancer was the main diagnosis. Apart from cancer, cardiovascular and musculoskeletal diagnoses were common. Patients with cancer who had multiple diagnoses or psychological diagnoses did not consult their GP significantly more often than patients with cancer without such comorbidity. CONCLUSION This study confirms that patients with cancer consult their GP more often than other patients, both for cancer-related reasons and for various comorbidities. A formalised follow-up by GPs would probably be feasible, and GPs should prepare for this responsibility.
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Affiliation(s)
- Heidi Lidal Fidjeland
- Doctoral Research Fellow, General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Doctoral Research Fellow, Department of Obstetrics and Gynecology, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Ingvild Vistad
- Consultant, Department of Obstetrics and Gynecology, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Svein Gjelstad
- Associate Professor, General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mette Brekke
- Professor, General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Abstract
Purpose: Cancer is a chronic illness with acute episodes lasting for years. Most cancer patients have coexisting comorbidities, which affect cancer treatment outcomes and make a shared care model for chronic diseases essential. There is a considerable gap between the achievable and delivered quality of care for cancer patients. Methods: We used a case study approach to examine the complexity of cancer management, from the perspective of one person's case as interpreted by the care team. It allowed the complexity of cancer management to retain its holistic and meaningful characteristics. We interviewed the patient, caregiver, primary care physician (PCP), and oncologist. Interviews were audio recorded and analyzed with ATLASti, qualitative statistical software. Participants also completed a basic demographic survey. Common themes were identified, analyzed, and discussed. Results: Main themes were lack of longitudinal relationship with PCP, communication barriers, and ambiguous health care provider roles. Communication barriers can be associated with the other two main themes. Conclusion: Our results showed that shared care for cancer management is lacking during the acute cancer treatment phase. Communication barriers between the PCP and oncologist along with lack of continuity of care and unclear role of the PCP are major contributors for fragmented cancer care in U.S. health care system.
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Affiliation(s)
- Saima Siddiqui
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Inez Cruz
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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14
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Banks I, Weller D, Ungan M, Selby P, Aapro M, Beishon M, Bolt M, Bonanno F, Champeix C, Dégi C, Eneqvist LJ, Kazmierska J, Kolacinska A, Malas S, Moine S, Pavlic DR, Price R, Walter F, Wyld L. ECCO Essential Requirements for Quality Cancer Care: Primary care. Crit Rev Oncol Hematol 2019; 142:187-199. [PMID: 31445441 DOI: 10.1016/j.critrevonc.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/03/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND ECCO Essential Requirements for Quality Cancer Care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to cancer patients. They are written by European experts representing all disciplines involved in cancer care. This paper concerns the integration of primary care into care for all cancers in Europe. Primary care integration.
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Affiliation(s)
- Ian Banks
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); European Men's Health Forum
| | - David Weller
- World Organization of Family Doctors (WONCA Europe); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mehmet Ungan
- World Organization of Family Doctors (WONCA Europe); Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Peter Selby
- European Cancer Concord (ECC); Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | - Matti Aapro
- European Cancer Organisation (ECCO); Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Marije Bolt
- Council of Occupational Therapists for European Countries (COTEC)
| | - Fiona Bonanno
- European Society of Oncology Pharmacy (ESOP); Sir Anthony Mamo Oncology Centre, Malta
| | | | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Lisa Jelf Eneqvist
- European Oncology Nursing Society (EONS); Regional Cancercenter Stockholm-Gotland, Sweden
| | - Joanna Kazmierska
- European Society of Radiotherapy and Oncology (ESTRO); Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland
| | - Agnieszka Kolacinska
- European Society of Surgical Oncology (ESSO); Department of Head and Neck Cancer Surgery and Surgical Oncology, Medical University of Lodz, Lodz, Poland
| | - Simon Malas
- Association of European Cancer Leagues (ECL); Oncology Clinic, Limassol General Hospital, Limassol, Cyprus
| | - Sébastien Moine
- European Association of Palliative Care (EAPC); Education and Health Practices Laboratory, University of Paris, France
| | | | | | - Fiona Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Lynda Wyld
- European Society of Breast Cancer Specialists (EUSOMA); Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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15
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Stegmann ME, Homburg TM, Meijer JM, Nuver J, Havenga K, Hiltermann TJN, Maduro JH, Schuling J, Brandenbarg D, Berendsen AJ. Correspondence between primary and secondary care about patients with cancer: a Delphi consensus study. Support Care Cancer 2019; 27:4199-4205. [PMID: 30825025 PMCID: PMC6803614 DOI: 10.1007/s00520-019-04712-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To provide optimal care for patients with cancer, timely and efficient communication between healthcare providers is essential. In this study, we aimed to achieve consensus regarding the desired content of communication between general practitioners (GPs) and oncology specialists before and during the initial treatment of cancer. METHODS In a two-round Delphi procedure, three expert panels reviewed items recommended for inclusion on referral and specialist letters. RESULTS The three panels comprised 39 GPs (42%), 42 oncology specialists (41%) (i.e. oncologists, radiotherapists, urologists and surgeons) and 18 patients or patient representatives (69%). Final agreement was by consensus, with 12 and 35 items included in the GP referral and the specialist letters, respectively. The key requirements of GP referral letters were that they should be limited to medical facts, a short summary of symptoms and abnormal findings, and the reason for referral. There was a similar requirement for letters from specialists to include these same medical facts, but detailed information was also required about the diagnosis, treatment options and chosen treatment. After two rounds, the overall content validity index (CVI) for both letters was 71%, indicating that a third round was not necessary. DISCUSSION This is the first study to differentiate between essential and redundant information in GP referral and specialist letters, and the findings could be used to improve communication between primary and secondary care.
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Affiliation(s)
- M E Stegmann
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands.
| | - T M Homburg
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - J M Meijer
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - J Nuver
- University Medical Center Groningen, Department of Medical Oncology, University of Groningen, Groningen, The Netherlands
| | - K Havenga
- University Medical Center Groningen, Department of Surgery, University of Groningen, Groningen, The Netherlands
| | - T J N Hiltermann
- University Medical Center Groningen, Department of Pulmonary Diseases, University of Groningen, Groningen, The Netherlands
| | - J H Maduro
- University Medical Center Groningen, Department of Radiation Oncology, University of Groningen, Groningen, The Netherlands
| | - J Schuling
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - D Brandenbarg
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - A J Berendsen
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
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16
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Cohen Castel O, Dagan E, Keinan-Boker L, Shadmi E. Reliability and validity of the Hebrew version of the Nijmegen Continuity Questionnaire for measuring patients' perceived continuity of care in oral anticancer therapy. Eur J Cancer Care (Engl) 2018; 27:e12913. [PMID: 30238665 DOI: 10.1111/ecc.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/11/2018] [Accepted: 08/14/2018] [Indexed: 12/14/2022]
Abstract
To assess the validity and reliability of the Nijmegen Continuity Questionnaire in Hebrew (NCQ-H) for measuring patients' perceived continuity of care in the multiprovider setting of oral anticancer therapy (OACT). Following forward-backward translation of the original instrument into Hebrew, the NCQ-H was administered to adult cancer patients in five oncology centres in Israel, 2-3 months after initiation of OACT (either targeted, hormonal or chemotherapy). Confirmatory factor analysis and Cronbach's alpha were used to assess the validity and reliability of the NCQ-H respectively. A total of 135 patients completed the questionnaire. The postanalysis models for measuring "personal continuity with care provider" (eight items for each provider: the oncology specialist and the primary care physician), and "team/cross-boundary continuity" (four items for each setting: within the oncology team, and between the oncology specialist and the primary care physician) showed good fit for the observed data (root-mean-square error of approximation (RMSEA) = 0.02; RMSEA = 0.015; for each model respectively). Cronbach's alpha was 0.79-0.95 for all subscales. Conclusions. This study provides preliminary evidence for the reliability and validity of the NCQ-H in assessing cancer patients' experience with continuity of care and for its usability in the context of OACT.
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Affiliation(s)
- Orit Cohen Castel
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Efrat Dagan
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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17
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Stegmann ME, Meijer JM, Nuver J, Havenga K, Hiltermann TJN, Maduro JH, Schuling J, Berendsen AJ. Correspondence between primary and secondary care about patients with cancer: A qualitative mixed-methods analysis. Eur J Cancer Care (Engl) 2018; 28:e12903. [PMID: 30138956 PMCID: PMC6588262 DOI: 10.1111/ecc.12903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 04/24/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
Cancer care is complex and involves many different healthcare providers, especially during diagnosis and initial treatment, and it has been reported that both general practitioners and oncology specialists experience difficulties with interdisciplinary communication. The aim of this qualitative study was to explore information sharing between primary and secondary care for patients with lung, breast or colorectal cancer. A qualitative content analysis of 50 medical files (419 documents) was performed, which identified 70 correspondence‐related items. Six main topics were identified in most referral letters from primary to secondary care, but it was particularly notable that highly relevant information regarding the past medical history was often mixed with less relevant information. To lesser extents, the same held true for the medication list and presenting history. In the letters from specialists, nine topics were identified in most letters. Although information about actual treatment was always present, only limited detail, if any, was given about the intent of the treatment (curative or palliative) or the treatment alternatives. Interviews with nine healthcare providers confirmed these issues. These findings indicate that neither the initial referral nor the specialist correspondence is tailored to the needs of the recipient.
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Affiliation(s)
- Mariken E Stegmann
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - Jiska M Meijer
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - Janine Nuver
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - Klaas Havenga
- University of Groningen, University Medical Center Groningen, Department of Abdominal Surgery, Groningen, The Netherlands
| | - Thijo J N Hiltermann
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - John H Maduro
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
| | - Jan Schuling
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - Annette J Berendsen
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
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18
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Possible missed opportunities for diagnosing colorectal cancer in Dutch primary care: a multimethods approach. Br J Gen Pract 2017; 68:e54-e62. [PMID: 29203683 DOI: 10.3399/bjgp17x693905] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early detection of colorectal cancer (CRC) is important to achieve better survival. Discriminating symptoms suggestive of CRC from benign conditions is a challenge for GPs because most known 'alarm symptoms' have low predictive values. AIM To further understand the diagnostic process of CRC in general practice in terms of healthcare use and by analysing factors related to diagnostic intervals. DESIGN AND SETTING A multimethod approach comprising a historical, prospective registry study and qualitative content analysis. METHOD Healthcare use in the year before referral for colonoscopy was compared between patients diagnosed with CRC and an age-, sex,- and GP-matched control population. Qualitative content analysis was performed on free texts in electronic patient records from a purposive sample of patients with CRC. RESULTS Patients with CRC (n = 287) had 41% (25-59%) more face-to-face contacts and 21% (7-37%) more medication prescriptions than controls (n = 828). Forty-six per cent of patients with CRC had two or more contacts for digestive reasons, compared with 12.2% of controls, more often for symptoms than diagnoses. From qualitative analysis two themes emerged: 'possible missed diagnostic opportunities' and 'improvements in diagnostic process unlikely'. Possible missed diagnostic opportunities were related to patients waiting before presenting symptoms, doctors attributing symptoms to comorbid conditions or medication use, or doctors sticking to an initial diagnosis. CONCLUSION Fewer missed diagnostic opportunities might occur if GPs are aware of pitfalls in diagnosing CRC: the assumption that symptoms are caused by comorbid conditions or medication, or relating complaints to pre-existing medical conditions. GPs also need to be aware that repeated digestive complaints warrant rethinking an earlier diagnosis.
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19
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Şahin MK, Aker S. Family Physicians' Knowledge, Attitudes, and Practices Toward Colorectal Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:908-913. [PMID: 27193411 DOI: 10.1007/s13187-016-1047-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to assess family physicians' knowledge, attitudes, and practices toward colorectal cancer (CRC) screening. The population in this cross-sectional study consisted of 290 family physicians working in Samsun, Turkey, contacted between 15 June and 15 July 2015 and agreeing to participate. A questionnaire prepared by the authors on the basis of the relevant literature was applied at face-to-face interviews. The first part of the questionnaire inquired into sociodemographic information, while the second contained questions evaluating family physicians' knowledge, attitudes, and practices toward CRC screening. Physicians completed the questionnaire in approximately 10 min. 65.9 % of the family physicians in the study were men. Mean age of the participants was 43.40 ± 6.54 years, and mean number of years in service was 18.43 ± 6.42. The average number of patients seen by physicians on a daily basis was 51-99. CRC screening was performed by 83.1 % of physicians. The fecal occult blood test (FOBT) was recommended at the correct frequency by 30.7 % of physicians and colonoscopy by 11.7 %. A further 68.6 % of physicians followed no CRC guideline. Only 3.8 % of those reporting using a guideline were able to name it. The great majority of physicians in this study apply CRC screening. However, family physicians lack sufficient information concerning the ages at which screening tests should be started and concluded and how frequently they should be performed. They also do not attach sufficient importance to CRC guidelines. This results in excessive demand for screening tests.
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Affiliation(s)
- Mustafa Kürşat Şahin
- Samsun Public Health Directorate, Canik Community Health Center, Gaziosmanpaşa Mah. Alaca Sok. No: 31, Canik, Samsun, Turkey.
| | - Servet Aker
- Samsun Public Health Directorate, Canik Community Health Center, Gaziosmanpaşa Mah. Alaca Sok. No: 31, Canik, Samsun, Turkey
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20
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Brandenbarg D, Roorda C, Stadlander M, de Bock GH, Berger MY, Berendsen AJ. Patients' views on general practitioners' role during treatment and follow-up of colorectal cancer: a qualitative study. Fam Pract 2017; 34:234-238. [PMID: 27920118 DOI: 10.1093/fampra/cmw124] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To clarify experiences and preferences of patients regarding the current and future role of GPs during treatment and follow-up care of colorectal cancer (CRC). METHODS Qualitative semi-structured, audio-recorded, face-to-face interviews in patients' homes in the north of the Netherlands were performed. Patients were sampled purposively on age, gender, time since diagnoses and primary health care use. Data were transcribed verbatim and analysed thematically by two independent researchers until saturation was reached. RESULTS Twenty-two patients were interviewed. GPs played a significant and highly valued role directly after surgery by proactively contacting their patients and offered support in clarification of medical issues, lifestyle advice and care for treatment-related side effects. During follow-up, GPs provided psychosocial support for patients and family members, besides routine health care. Concerning the organization of future follow-up care, most patients expressed a preference for specialist-led services; some said that primary care-led care would be more accessible and less expensive. CONCLUSION Although at present patients perceived their GP is involved in CRC care, they would prefer their follow-up care in a hospital setting. If, in line with recent insights, future follow-up care might become more relying on testing for markers instead of imaging, there may be scope for incorporating this care in current GP routines.
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Affiliation(s)
- Daan Brandenbarg
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carriene Roorda
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michelle Stadlander
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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21
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Duthie K, Strohschein FJ, Loiselle CG. Living with cancer and other chronic conditions: Patients' perceptions of their healthcare experience. Can Oncol Nurs J 2017; 27:43-48. [PMID: 31148776 DOI: 10.5737/236880762714348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Multimorbidity is known to contribute to the complexity of care for patients with cancer. This qualitative study begins to explore cancer patients' experience with multimodal treatments, that is, treatments for multiple chronic conditions, as well as issues related to navigating the healthcare system. Participants (n=10) were recruited from an ambulatory cancer centre in a large, university-affiliated hospital in Montreal, Quebec. Important challenges were reported in terms of striking a fine balance between acute health needs and underlying ongoing chronic condition(s), experiencing unforeseen treatment complications, and negotiating silos across medical specialties. Participants also wished to be better known by the healthcare team. When reporting a positive care coordination experience, participants often attributed it to the intervention by a nurse navigator. Lastly, participants expected a more personalized care approach and would have liked to be included in multidisciplinary board meetings. Study results underscore the impetus to better integrate care across diseases, enhance person-centred care, and support patients who strive to balance competing needs when facing multimorbidity.
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Affiliation(s)
- Kia Duthie
- Staff Nurse, BC Cancer Agency, 401 - 122, Walter Hardwick Ave, Vancouver, BC V5Y 0C9, 514-726-3902;
| | - Fay J Strohschein
- Ingram School of Nursing, McGill University, Nursing Counsellor, Segal Cancer Centre, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Rd, Pav. H-304.4, Montreal, QC H3T 1E2, 514-340-8222 ext. 3864;
| | - Carmen G Loiselle
- Associate Professor, Department of Oncology and Ingram School of Nursing, McGill University, Co-Director (Academic) and Senior Investigator, Segal Cancer Centre, Jewish General Hospital, 3755 Côte-Sainte-Catherine Rd, Pav. E-748, Montreal, QC H3T 1E2, 514-340-8222 ext. 3940;
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22
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Brandenbarg D, Roorda C, Groenhof F, de Bock GH, Berger MY, Berendsen AJ. Primary healthcare use during follow-up after curative treatment for colorectal cancer. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12581] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- D. Brandenbarg
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - C. Roorda
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - F. Groenhof
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - G. H. de Bock
- Department of Epidemiology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - M. Y. Berger
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - A. J. Berendsen
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
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23
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Jiang L, Lofters A, Moineddin R, Decker K, Groome P, Kendell C, Krzyzanowska M, Li D, McBride ML, Mittmann N, Porter G, Turner D, Urquhart R, Winget M, Zhang Y, Grunfeld E. Primary care physician use across the breast cancer care continuum: CanIMPACT study using Canadian administrative data. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e589-e598. [PMID: 27737994 PMCID: PMC5063785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe primary care physician (PCP) use and continuity of PCP care across the breast cancer care continuum. DESIGN Population-based, retrospective cohort study using provincial cancer registries linked to health administrative databases. SETTING British Columbia, Manitoba, and Ontario. PARTICIPANTS All women with incident invasive breast cancer from 2007 to 2012 in Manitoba and Ontario and from 2007 to 2011 in British Columbia. MAIN OUTCOME MEASURES The number and proportions of visits to PCPs were determined. Continuity of care was measured using the Usual Provider of Care index calculated as the proportion of visits to the most-often-visited PCP in the 6 to 30 months before a breast cancer diagnosis (baseline) and from 1 to 3 years following a breast cancer diagnosis (survivorship). RESULTS More than three-quarters of patients visited their PCPs 2 or more times during the breast cancer diagnostic period, and more than 80% of patients had at least 1 PCP visit during breast cancer adjuvant treatment. Contact with the PCP decreased over time during breast cancer survivorship. Of the 3 phases, women appeared to be most likely to not have PCP contact during adjuvant treatment, with 10.7% (Ontario) to 18.7% (British Columbia) of women having no PCP visits during this phase. However, a sizable minority of women had at least monthly visits during the treatment phase, particularly in Manitoba and Ontario, where approximately a quarter of women saw a PCP at least monthly. We observed higher continuity of care with PCPs in survivorship (compared with baseline) in all provinces. CONCLUSION Primary care physicians were generally involved throughout the breast cancer care continuum, but the level of involvement varied across care phases and by province. Future interventions will aim to further integrate primary and oncology care.
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Affiliation(s)
- Li Jiang
- Epidemiologist with the Institute for Clinical Evaluative Sciences at Queen's University in Kingston, Ont.
| | - Aisha Lofters
- Assistant Professor and Clinician Scientist in the Department of Family and Community Medicine at the University of Toronto in Ontario
| | - Rahim Moineddin
- Professor and a senior biostatistician in the Department of Family and Community Medicine at the University of Toronto
| | - Kathleen Decker
- Senior epidemiologist in the Epidemiology and Cancer Registry Department at CancerCare Manitoba and Assistant Professor in the Department of Community Health Sciences at the University of Manitoba in Winnipeg
| | - Patti Groome
- Senior scientist in the Division of Cancer Care and Epidemiology at the Queen's Cancer Research Institute and Professor in the Department of Public Health Sciences at Queen's University
| | - Cynthia Kendell
- Doctoral candidate and Project Coordinator with the Cancer Outcomes Research Program at Dalhousie University in Halifax, NS
| | - Monika Krzyzanowska
- Researcher with the University Health Network and Clinical Lead of Quality Care and Access for the Systemic Treatment Program at Cancer Care Ontario in Toronto
| | - Dongdong Li
- Biostatistical research methodologist at the BC Cancer Agency in Vancouver
| | - Mary L McBride
- Distinguished Scientist in Cancer Control Research for the BC Cancer Agency and Clinical Professor in the School of Population and Public Health at the University of British Columbia
| | | | - Geoff Porter
- Professor and Ramia Chair in Surgical Oncology at Dalhousie University
| | - Donna Turner
- Epidemiologist and Provincial Director of the Population Oncology portfolio at CancerCare Manitoba, and Associate Professor in the Department of Community Health Sciences at the University of Manitoba
| | - Robin Urquhart
- Assistant Professor and Ramia Scientist in the Department of Surgery at Dalhousie University
| | - Marcy Winget
- Clinical Associate Professor in the School of Medicine at Stanford University in California
| | - Yang Zhang
- Biostatistical research methodologist at the BC Cancer Agency
| | - Eva Grunfeld
- Giblon Professor and Vice-Chair of Research in the Department of Family and Community Medicine at the University of Toronto and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research
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24
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Hussain T, Chang HY, Luu NP, Pollack CE. The Value of Continuity between Primary Care and Surgical Care in Colon Cancer. PLoS One 2016; 11:e0155789. [PMID: 27219454 PMCID: PMC4878733 DOI: 10.1371/journal.pone.0155789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 04/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Improving continuity between primary care and cancer care is critical for improving cancer outcomes and curbing cancer costs. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs. METHODS Using Surveillance, Epidemiology, and End Results Program Registry (SEER)-Medicare data, we performed a retrospective cohort study of stage I-III colon cancer patients diagnosed between 2000 and 2009. There were 23,305 stage I-III colon cancer patients who received primary care in the year prior to diagnosis and underwent operative care for colon cancer. Patients were assigned to the hospital where they had their surgery and to their primary care provider's main hospital, and then classified according to whether these two hospitals were same or different. Outcomes examined were hazards for all-cause mortality, subhazard for colon cancer specific mortality, and generalized linear estimate for costs at 12 months, from propensity score matched models. RESULTS Fifty-two percent of stage I-III colon patients received primary care and surgical care from the same hospital. Primary care and surgical care from the same hospital was not associated with reduced all-cause or colon cancer specific mortality, but was associated with lower inpatient, outpatient, and total costs of care. Total cost difference was $8,836 (95% CI $2,746-$14,577), a 20% reduction in total median cost of care at 12 months. CONCLUSIONS Receiving primary care and surgical care at the same hospital, compared to different hospitals, was associated with lower costs but still similar survival among stage I-III colon cancer patients. Nonetheless, health care policy which encourages further integration between primary care and cancer care in order to improve outcomes and decrease costs will need to address the significant proportion of patients receiving health care across more than one hospital.
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Affiliation(s)
- Tanvir Hussain
- Department of Medicine, Division of General Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
| | - Hsien-Yen Chang
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ngoc-Phuong Luu
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Craig Evan Pollack
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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25
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Meiklejohn JA, Mimery A, Martin JH, Bailie R, Garvey G, Walpole ET, Adams J, Williamson D, Valery PC. The role of the GP in follow-up cancer care: a systematic literature review. J Cancer Surviv 2016; 10:990-1011. [PMID: 27138994 DOI: 10.1007/s11764-016-0545-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 04/22/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of the present study is to explore the role of the general practitioners, family physicians and primary care physicians (GP) in the provision of follow-up cancer care. METHODS PubMed, MEDLINE and CINAHL were systematically searched for primary research focussing on the role of the GP from the perspective of GPs and patients. Data were extracted using a standardised form and synthesised using a qualitative descriptive approach. RESULTS The initial search generated 6487 articles: 25 quantitative and 33 qualitative articles were included. Articles focused on patients' and GPs' perspectives of the GP role in follow-up cancer care. Some studies reported on the current role of the GP, barriers and enablers to GP involvement from the perspective of the GP and suggestions for future GP roles. Variations in guidelines and practice of follow-up cancer care in the primary health care sector exist. However, GPs and patients across the included studies supported a greater GP role in follow-up cancer care. This included greater support for care coordination, screening, diagnosis and management of physical and psychological effects of cancer and its treatment, symptom and pain relief, health promotion, palliative care and continuing normal general health care provision. CONCLUSION While there are variations in guidelines and practice of follow-up cancer care in the primary health care sector, GPs and patients across the reviewed studies supported a greater role by the GP. IMPLICATIONS FOR CANCER SURVIVORS Greater GP role in cancer care could improve the quality of patient care for cancer survivors. Better communication between the tertiary sector and GP across the cancer phases would enable clear delineation of roles.
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Affiliation(s)
| | - Alexander Mimery
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Jennifer H Martin
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Southside Clinical School, University of Queensland, Brisbane, QLD, Australia
| | - Ross Bailie
- National Centre for Quality Improvement in Indigenous Primary Health Care, Menzies School of Health Research, Brisbane, Australia
| | - Gail Garvey
- Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Euan T Walpole
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,Metro South Health Hospital and Health Service, Woolloongabba, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Jon Adams
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Daniel Williamson
- Aboriginal and Torres Strait Islander Health Unit, Queensland Health, Brisbane, QLD, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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26
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Heins MJ, Korevaar JC, Hopman PE, Donker GA, Schellevis FG, Rijken MP. Health-related quality of life and health care use in cancer survivors compared with patients with chronic diseases. Cancer 2016; 122:962-70. [DOI: 10.1002/cncr.29853] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/23/2015] [Accepted: 11/19/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Marianne J. Heins
- Netherlands Institute for Health Services Research (NIVEL); Utrecht the Netherlands
| | - Joke C. Korevaar
- Netherlands Institute for Health Services Research (NIVEL); Utrecht the Netherlands
| | - Petra E.P.C. Hopman
- Netherlands Institute for Health Services Research (NIVEL); Utrecht the Netherlands
| | - Gé A. Donker
- Netherlands Institute for Health Services Research (NIVEL); Utrecht the Netherlands
| | - François G. Schellevis
- Netherlands Institute for Health Services Research (NIVEL); Utrecht the Netherlands
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam the Netherlands
| | - Mieke P.M. Rijken
- Netherlands Institute for Health Services Research (NIVEL); Utrecht the Netherlands
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27
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Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C. The expanding role of primary care in cancer control. Lancet Oncol 2015; 16:1231-72. [PMID: 26431866 DOI: 10.1016/s1470-2045(15)00205-3] [Citation(s) in RCA: 355] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
Abstract
The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.
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Affiliation(s)
- Greg Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK.
| | - Annette Berendsen
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | | | - Rachel Dommett
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Craig Earle
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Jon Emery
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Tom Fahey
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Sumit Gupta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - David Hunter
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | | | - Una Macleod
- Hull-York Medical School, University of Hull, Hull, UK
| | - Robert Mason
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Geoffrey Mitchell
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | | | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bohumil Seifert
- Department of General Practice, Charles University, Prague, Czech Republic
| | - Jeff Sisler
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Stephen Taplin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Peter Vedsted
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Teja Voruganti
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fiona Walter
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eila Watson
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Jeremy Whelan
- Research Department of Oncology, University College London, London, UK
| | - James Whitlock
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | - Niek de Wit
- Department of General Practice, University Medical Center Utrecht, Utrecht, Netherlands
| | - Camilla Zimmermann
- Division of Medical Oncology and Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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28
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Fidjeland HL, Brekke M, Vistad I. General practitioners' attitudes toward follow-up after cancer treatment: A cross-sectional questionnaire study. Scand J Prim Health Care 2015; 33:223-32. [PMID: 26649452 PMCID: PMC4750731 DOI: 10.3109/02813432.2015.1118836] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE An increasing number of cancer patients place a significant workload on hospital outpatient clinics, and health authorities are considering alternative follow-up regimens. It has been suggested that follow-up of cancer patients could be provided by GPs. This study aimed to explore GPs' experiences with the provision of follow-up care for cancer patients, and their views on assuming greater responsibility in the future. DESIGN Electronic questionnaire study. SUBJECTS GPs in seven regions in Norway. RESULTS A total of 317 GPs responded. Many GPs reported experience in providing follow-up care to cancer patients, during the years following initial diagnosis primarily in collaboration with hospital specialists. More than half of the GPs were satisfied with their collaboration. Most GPs preferred to be involved at an early stage in follow-up care and, generally, GPs felt confident in their skills to provide this type of service. Fewer than 10% were willing to assume responsibility for additional cancer patients, citing potentially increased workload as the main reason. CONCLUSIONS GPs acknowledged the importance of providing follow-up care to cancer patients, and the majority felt confident in their own ability to provide such care. However, they were hesitant to assume greater responsibility primarily due to fears of increased workload. Key Points It has been suggested that follow-up of cancer patients can be provided by general practitioners (GPs). The viewpoints and attitudes of GPs regarding such follow-up were investigated. GPs reported broad experience in providing follow-up care to patients after active cancer treatment. GPs acknowledged the importance of follow-up care, and they felt confident in their own ability to provide such care. Fewer than 10% of GPs were willing to assume responsibility for additional cancer patients, citing potentially increased workload as the main reason.
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Affiliation(s)
| | - Mette Brekke
- Department of General Practice, Institute of Health and Society, University of Oslo, Norway
| | - Ingvild Vistad
- Department of Obstetrics and Gynaecology, Sørlandet Hospital, Kristiansand, Norway
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